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Infectious diseases Flashcards

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1
Q

What are some causes of atypical pneumonia?

A

legionella pneumophilia
Mycoplasma pneumonia
Chlamydia

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2
Q

What are causes of atypical pneumonia in HIV patients?

A

Aspergillus

Pneumocystis jiroveci

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3
Q

What are causes of atypical pneumonia in CF patients?

A

Pseudomonas

Burkholderia

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4
Q

How are atypical pneumonias treated?

A

Clarithromycin

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5
Q

What are causes of typical pneumonia

A

strep pneumoniae
h. influenzae
staph aureus
klebsiella pneumoniae

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6
Q

how is typical pneumonia treated?

A

amoxicillin if mild

co-amoxiclav and macrolide e.g. erythromycin if moderate or severe

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7
Q

what type of organism is strep pneumoniae?

A

gram positive diplococcus

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8
Q

when is staph aureus pneumonia common?

A

post influenza

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9
Q

what makes up a bacterial cell wall?

A

peptidoglycan

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10
Q

what electrolyte imbalance does legionella pneumophiliacause?

A

low sodium

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11
Q

what is the motor response in GCS?

A
  1. Obeys commands
  2. Localises to pain
  3. Withdraws from pain
  4. Abnormal flexion to pain (decorticate posture)
  5. Extending to pain
  6. None
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12
Q

what is the verbal response in GCS?

A
  1. Orientated
  2. Confused
  3. Words
  4. Sounds
  5. None
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13
Q

what is the eye response in GCS?

A
  1. Spontaneous
  2. To speech
  3. To pain
  4. None
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14
Q

what investigation needs to be done if you suspect legionella pneumonia?

A

urinary antigens
sputum culture and PCR for chlamydia or mycoplasma differential
CXR

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15
Q

what are the potential complications of legionella pneumonia?

A 
sepsis
hyponatraemia
renal failure
pleural effusion
abscesses
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16
Q

what is legionella pneumonia associated with?

A

colonises water tanks e.g. holidays/air con

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17
Q

what drug should be given before results of urinary antigens come back in atypical pneumonia?

A

tazocin

tx of legionella is erythromycin/clarithromycin but give broad spec before confirmation

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18
Q

Ix in meningitis?

A 
full blood count
CRP
coagulation screen
blood culture
whole-blood PCR
blood glucose
blood gas
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19
Q

immediate management if meningococcal septicaemia suspected?

A

IM benzylpenicillin

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20
Q

what is initial empirical therapy aged > 50 years for meningococcal septicaemia?

A

Intravenous cefotaxime + amoxicillin

amoxicillin is for listeria cover, only if >50

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21
Q

what is meds used for meningitis caused by listeria?

A

Intravenous amoxicillin + gentamicin

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22
Q

what is the treatment of meningitis if penicillin allergic?

A

chloramphenicol

if amoxicillin allergic- cotrimoxazole

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23
Q

what is also given in meningitis to reduce neurological sequale?

A

dexamethasone

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24
Q

what is the rash expected in meningococcal septicaemia?

A

non-blanching purpura

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25
when couldn't you do a LP?
raised ICP | don't need to do if the patient has a rash
26
name some bacterial causes of meningitis? (>6 years)
``` Neisseria meningitidis (meningococcus) Streptococcus pneumoniae (pneumococcus) ```
27
name some bacterial causes of meningitis in neonates to 3 months?
Group B Streptococcus: usually acquired from the mother at birth. More common in low birth weight babies and following prolonged rupture of the membranes E. coli and other Gram -ve organisms Listeria monocytogenes
28
name some bacterial causes of meningitis in 3 months to 6 years?
``` Neisseria meningitidis (meningococcus) Streptococcus pneumoniae (pneumococcus) Haemophilus influenzae ```
29
what are classic signs and symptoms of meningitis?
``` headache fever nausea/vomiting photophobia drowsiness seizures ``` Signs: neck stiffness purpuric rash
30
what are the CSF finding in bacterial meningitis?
cloudy high protein low glucose 10 - 5,000 polymorphs/mm³
31
what are the CSF finding in viral meningitis?
clear normal/raised protein high glucose lymphocytes
32
what are the CSF findings in TB meningitis?
slightly cloudy high protein low glucose lymphocytes
33
who needs to informed if a diagnosis of bacterial meningitis?
Public health england
34
name some viral causes of meningitis?
Viral enterococcus | HSV
35
what is prophylaxis of close contacts of meningitis?
ciprofloxacin (recommended)or rifampicin
36
name the species of malaria?
P.falciparum (most common and severe) P.vivax P.ovale P.malariae
37
how is malaria transmitted?
by the bite of the female anopheline mosquito
38
what are the features of malaria?
``` severe headache fever/ cold/ sweating splenomegaly dry cough myalgia D&V ```
39
what is a protective factor for malaria?
sickle cell trait (HbS)
40
Ix for malaria
``` 3 x thick and thin blood films (thick= diagnostic) (thin= species) bloods inc coag screen and LFTs RDT (antigen test) ```
41
mx of falciparum malaria?
most are resistant to chloroquine - IV artesunate if severe - ACTS if uncomplicated - fluids and ITU support
42
mx of other strains of malaria?
quinine | artemisinin-based combination therapy (ACT) or chloroquine
43
complications of severe malaria?
``` DIC multi-organ failure seizures and coma death ARDS shock sepsis ```
44
malarial prophylaxis drugs?
doxycycline- 2 weeks prior and 4 weeks after malarone- 2 days before and 7 days after methequine- taken weekly
45
SEs of doxycycline?
sunlight hypersensitivity, nausea and diarrhoea
46
SEs of methequine?
neuropsychiatric SEs- anxiety and hallucinations
47
common causes of gastroenteritis?
Viral- Rotavirus Norovirus Adenovirus Bacterial- E.coli, Campylobacter jejuni, shigella, salmonella, bacillus cereus, giardia, staph aureus
48
what are the 4C's that are associated with C.diff infection?
clindamycin, cephalosporins, co‐amoxiclav and ciprofloxacin
49
what condition can C.diff infection lead to?
pseudomembranous colitis
50
features of C. diff infection?
diarrhoea abdominal pain a raised white blood cell count is characteristic if severe toxic megacolon may develop
51
diagnosis of C.diff
is made by detecting Clostridium difficile toxin (CDT) in the stool
52
mx of C.diff
1st line- metronidazole | 2nd line- vancomycin
53
features of E.coli infection?
``` most common cause of GE travellers watery stools abdo pains nausea It is spread through contact with infected faeces, unwashed salads or water. E. coli 0157 produces the Shiga toxin- can lead to haemolytic uraemic syndrome no ABX tx ```
54
features of giardia infection?
prolonged, non bloody diarrhoea | tx= metronidazole
55
features of cholera?
profuse, watery diarrhoea hypoglycaemia severe dehydration resulting in weight loss travellers
56
features of shigella infection?
bloody diarrhoea vomiting and abdo pain Shigella is spread by faeces contaminating drinking water, swimming pools and food. Shigella can produce the Shiga toxin and cause haemolytic uraemic syndrome. Treatment of severe cases is with azithromycin or ciprofloxacin.
57
features of campylobacter infection?
flu-like prodrome followed by crampy abdo pains, fever and diarrhoea which may be bloody may mimic appendicitis It is spread by: Raw or improperly cooked poultry Untreated water Unpasteurised milk
58
what typically causes bacillus cereus infection?
rice
59
features of amoebiasis infection?
gradual onset bloody diarrhoea | abdo pain and tenderness which may last for several weeks
60
mx of campylobacter?
Clarithromycin
61
mx of salmonella and shigella
ciprofloxacin
62
what else needs to be done with infective GE?
The 'Proper Officer' at the Local Health Protection Team needs to be notified. They in turn will notify the Health Protection Agency on a weekly basis
63
how to tell if cellulitis has progressed to necrotising fasciitis?
pain disproportionate to injury
64
Ix for cellulitis?
bacterial= black swabs | blood cultures
65
what is HIV?
a single stranded RNA virus | causes host cells to produce virions which infect new cells with CD4 receptor
66
transmission of HIV?
``` needlestick sex IVDU blood products vertical transmission ```
67
diagnosis of HIV?
serology detect antibodies and antigens of the virus (can have false negative results up to 4 weeks post infection)
68
markers of disease progression in HIV?
CD4 cells | viral load
69
what does U=U mean?
undetectable viral load= untransmittable
70
what is at risk once CD4 count <200?
opportunistic infections e.g. PCP and toxoplasmosis
71
what is at risk once CD4 count <50?
MAI- mycobacterium avium intracellulare | CMV
72
when is AIDS diagnosed?
CD4 count <200
73
what are AIDs defining illnesses?
``` Kaposi’s sarcoma Pneumocystis jirovecii pneumonia (PCP) Cytomegalovirus infection Candidiasis (oesophageal or bronchial) Lymphomas Tuberculosis ```
74
Ix of PCP?
CD4 count and viral load CXR bronchio-alveolar lavage sputum culture
75
TX of PCP?
``` IV cotrimoxazole (oral when well) for 21 days steroids ```
76
tx of HIV?
antiretroviral therapy- | 2NRTIs plus PI or NNRTI
77
what is post-exposure prophylaxis for HIV?
zidovudine- within 72 hours of exposure | do pregnancy test before
78
prophylaxis of CMV?
gancyclovir
79
prophylaxis of PCP?
co-trimoxazole
80
differentials of jaundice in the UK?
``` hepatitis EBV CMV ascending cholangitis typhoid TB malaria leptospirosis ```
81
transmission of hep A?
faco-oral transmission (shellfish)
82
features of hep A?
Acute self-limiting jaundice and abdo pain IgM
83
tx of hep A
supportive vaccine
84
RFs of hep B?
``` IVDU multiple sexual partners blood products vertical transmission typically prisons, homeless, overcrowding ```
85
features of hep B?
acute- jaundice, malaise, abdo pain, N&V
86
Ix of hep B?
various antibodies PCR for viral load LFTs- high bilirubin, high ALT/AST, high ALP histology- ground glass hepatocytes
87
signs of previous vaccination
HBsAb
88
signs of chronic infection
HBcAb, HBs Ag, HBV-DNA
89
signs of infection cleared after exposure
HBsAb, HBcAb
90
tx of Hep B infection?
Screen for other blood born viruses (hepatitis A and B and HIV) and other sexually transmitted diseases Refer to gastroenterology, hepatology or infectious diseases for specialist management Notify Public Health (it is a notifiable disease) Stop smoking and alcohol Education about reducing transmission and informing potential at risk contacts Testing for complications: FibroScan for cirrhosis and ultrasound for hepatocellular carcinoma Antiviral medication- tenofevir or entecavir Liver transplantation for end-stage liver disease
91
prognosis of Heb B?
80% full recovery 10% chronic hepatitis 10% carriers
92
what to use as prophylaxis for transmission
HBIG | give within 24 hours of birth if vertical, followed by full vaccination course
93
transmission of Hep C?
blood products and sexually IVDU most common toothbrushes and razors
94
features of Hep C?
majority are asymptomatic | 10-15% have jaundice and other general symptoms
95
who needs to be screened for hep C?
any patient with a persistently elevated ALT
96
diagnosis of hep C?
``` serology- HCV antibody PCR- HCV PCR LFTs FBC U&Es ```
97
clinical assessment of the liver?
Fibroscan- assesses liver stiffness if advanced fibrosis- 6 monthly AFP and liver USS for screening of HCC OGD if gastric or oesophageal varices
98
features of liver failure?
coagulopathy- prolonged PT time splenomegaly varices
99
tx of hep C virus?
DAAs- direct acting antiviral drugs | monitor FBC, U&E and LFTs every 4 weeks and viral load
100
what is defined as cure for Hep C?
undetectable HCV RNA in the blood 12 weeks after the end of treatment
101
RFs for TB?
``` HIV overcrowding IVDU ethnic minorities homeless immunosuppression ```
102
what is the pathophysiology of TB?
mycobacterium tuberculosis -> engulfed by macrophages -> form granumoas -> GHON focus -> latent phase -> MTB enters bloodstream-> extra-pulmonary TB
103
features of TB?
pulmonary- cough +/- haemoptysis SOB fever, night sweats, weight loss, fatigue, lymphadenopathy extra pulmonary- TB meningitis, pericarditis, arthritis etc (anywhere in body)
104
test for latent TB?
Mantoux | quantiferon gold test
105
test for active TB?
CXR | sputum microscopy for acid fast bacilli (Ziehl-Neelson stain)
106
Tx of TB and tests to do beforehand?
Rifampicin Isoniazid Pyrazinamide Ethambutol U&Es, LFTs, FBC, vision testing
107
SE of rifampicin?
nausea, anorexia, red urine, hepatotoxicity
108
SE isoniazid?
N&V, constipation, peripheral neuropathy
109
SE pyrazinamide?
hepatoxicity, N&V, arthralgia, sideroblastic anaemia | increased uricaemia causing gout
110
SE ethambutol?
optic neuritis
111
prevention of TB?
notifiable disease prophylaxis of contacts BCG vaccine
112
what is infectious mononucleosis?
glandular fever
113
causes of glandular fever?
EBC CMV HHV-6
114
features in glandular fever?
sore throat, pyrexia and lymphadenopathy also splenomegaly, hepaitis
115
diagnosis of glandular fever?
monospot test and FBC
116
how long do you have to avoid playing contact sports in glandular fever?
8 weeks
117
cause of syphilis?
spirochaete e.g. treponema pallidum
118
primary features of syphilis?
chancre- painless ulcer at site of sexual contact | local non-tender lymphadenopathy
119
secondary infection in syphilis?
``` 6-10 weeks after primary infection fevers, lymphadenopathy rash on trunk, palms and soles buccal ulcers condylomata lata ```
120
tertiary features of syphilis?
gummas ascending aortic aneurysms Argyll Robertson pupil tabes dorsalis
121
Ix of syphilis?
``` rological tests can be divided into: cardiolipin tests (not treponeme specific) e.g. VDLR treponemal-specific antibody tests ```
122
tx of syphilis?
benzathine penicillin 1st line IM | alternative- doxycycline
123
what rash is sometimes seen following syphilis tx?
Jarisch-herxheimer
124
what disease is common in warm fresh water in the tropics? e.g. canoeing/sailing holidays
leptospirosis, leptospira interrogans | tx= doxycycline
125
complication of leptospirosis?
Weil's disease- jaundice occurs about 1 week after the onset of symptoms causes renal failure and major haemorrhage
126
characteristics of lyme disease and cause?
tick bite target-shaped rash, an erythematous macule spreads slowly from the centre can have joint involvement with a mono- or oligoarthritis
127
how to diagnose PCP?
bronchoalveolar lavage CXR- bilateral perihilar shadowing Cysts and trophozoites on microscopy of the sputum Exercise induced desaturations
128
tx of PCP?
Co-trimoxazole | + steroids if hypoxic
129
neurocomplications of HIV/
Cerebral toxoplasmosis - tx is sulfadiazine Cryptococcus meningitis Primary CNS lymphoma NHL CMV encephalitis Progressive multifocal leukoencephalopathy
130
Ix of viral hepatitis?
``` LFTs and clotting Hep B and C serology Alpha fetoprotein US scan of the liver Liver biopsy ```
131
what 2 STIs can present with a chancre?
syphilis | gonorrhoea
132
girl comes back from India with rigors, RUQ pain referred to shoulder and diarrhoea. Stool culture and microscopy shows cysts. What is the cause?
amoebiasis with liver abscess
133
ID that can cause gross eosinophilia?
parasitic worm infections due to pulmonary eosinophilia
134
complications of meningitis?
hearing loss seizures and epilepsy cognitive impairment memory loss
135
post gastroenteritis complications
Lactose intolerance Irritable bowel syndrome Reactive arthritis Guillain–Barré syndrome
136
GE management?
Stool MC&S Assess dehydration- fluid challenge Diaoralyte if necessary (rehydration) Advise them to stay off work or school for 48 hours after symptoms have completely resolved Antibiotics should only be given in patients that are at risk of complications and once the causative organism is confirmed.
137
how long do newborns of HIV positive mothers need treatment for?
4 weeks | can only be delivered by vagina if undetectable load

3b specialties (7 decks)

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