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EXAM PREP- YR 3 > Infectious diseases- Medicine > Flashcards

Infectious diseases- Medicine Flashcards

(91 cards)

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1
Q

Malaria- uncomplicated falciparum treatment

A

Artemether with lumefantrine (artemesinin combination therapy)
Or oral quinine plus doxycycline

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2
Q

Malaria- complicated/ severe Falciparum treatment

A

IV artesunate

IV quinine if artesunate not immediately available- continue till pt can complete full oral course of quinine

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3
Q

Malarial prophylaxis

A

Malarone = proguanil + atovaquone

Mefloquine (weekly)

Doxycycline

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4
Q

Malaria endemic areas (WHO)

A

Sub-saharan Africa- majority cases

Others- SE Asia, Eastern Mediterranean, Western Pacific, the Americas

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5
Q

Salmonella- gram pos or neg?

A

Gneg

Aerobic

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6
Q

Typhoid transmission

A

Faecal-oral route

Contaminated food and water

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7
Q

Relative bradycardia + fever…

A

= typhoid fever- pulse rate slow for high fever

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8
Q

Rose spots = ?

A

On chest and abdomen

Typhoid fever

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9
Q

Mx typhoid fever

A

IV ceftriaxone 2g OD
or Azithromycin
or PO Ciprofloxacin (once sensitivities identified)

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10
Q

Define PUO

A

Prolonged fever of > 3 weeks which resists diagnosis after a week in hospital

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11
Q

Typical exam Q patient with Tb

A

Productive cough
Sputum grows acid fast bacilli
Zeihl Neelson staining: red

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12
Q

Latent TB treatment

A

3 months isoniazid and rifampicin

or 6 months isoniazid alone

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13
Q

Active TB treatment

A

Rifampicin and isoniazid for 6 months

Pyrazinamide and ethambutol for first 2 months too

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14
Q

Side effects of Rifampicin

A

General- nausea, thrombocytopoenia, vomiting
Orange urine/ tears
Drug induced hepatitis
Reduces COCP efficacy/ other drugs that use CYP450 - is a potent liver enzyme inducer
(Red-and-orange-pissin)

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15
Q

Side effects of Isoniazid

A

Peripheral neuropathy (reduced by giving pyridoxine)
Colour blindness
Gynaecomastia
Drug induced hepatitis

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16
Q

Why is isoniazid given with pyridoxine?

A

Pyridoxine = B6
to reduce side effect of peripheral neuropathy that isoniazid can cause

(I’m-so-numb-azid)

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17
Q

Side effects of Pyrazinamide

A

Hyperuricaemia - gout
Arthralgia, myalgia
Drug induced hepatitis

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18
Q

Side effects of ethambutol

A

Optic neuropathy/ reduced VA/ colour blindness
-Check VA before + during treatment
(EYE-thambutol)

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19
Q

Causes of erythema nodosum

A 
Throat infections- strep
primary TB
Parasitic infections- amoebiasis
Chlamydia
HSV
Viral hepatitis
HIV

Inflammatory causes- IBD, sarcoidosis, lymphoma, leukaemia

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20
Q

What is ghon complex

A

Ghon focus (small lung lesion due to TB) plus hilar lymph nodes - usually in apical segment of R lower lobe

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21
Q

Where to look when given a TB CXR and you can’t see anything

A

Check the R middle zone

and upper zones -the most aerated portion of the lungs and tubercle bacilli like them

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22
Q

Pt exposed to HIV, no symptoms- do you test?

A

Yes at 4 wks

Then at 12 wks if negative result

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23
Q

What CD4 count = end stage HIV/ AIDs

A

Under 200

Risk of opportunistic infections eg PCP or cyatomegalovirus infection

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24
Q

HIV prophylaxis against PCP?

A

For CD4<200

Co-trimoxazole (septrin)

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25
HIV Vaccinations
``` Yearly influenza Pneumococcal once or twice a decade Hep A and B Tetanus Diphtheria Polio Avoid live vaccines ```
26
Who is offered ART
Anti-retroviral therapy | everyone with HIV regardless of viral load or CD4 count
27
When do people develop HIV antibodies by
4-6 weeks normally | definitely by 3 mnths
28
Screening HIV in pregnancy...
NICE recommends screening all pregnant women
29
Can HIV women breastfeed
No
30
What is meningococcous
Neisseria meningitidis Gneg diplococci
31
Most common cause of meningitis
Adults- Meningococcus Pneumococcus (strep pneumoniae) Neonates to 3mnths- GBS (group B strep) HI in up to 6yrs is also a possibility
32
Suspected meningitis + non-blanching rash, seen in GP, what to do?
Urgent IM benzylpenicillin (Or IV) prior to transfer to hospital Suspecting meningococcal meningitis
33
Why do we give dexamethasone in bacterial meningitis
To reduce the deafness and neurological damage
34
Typical abx treatment for bacterial meningitis
Under 3mnths- cefotaxime + amoxicillin Over 3mnths- ceftriaxone (cephalosporins) IV Vancomycin can be added if risk of resistant pneumococcal infection
35
When is amoxicillin added to cephalosporin treatment for bacterial meningitis
Cover for Listeria- for >55 years, or immunocompromised, or <3mnths
36
If a patient with TB develops a headache and neck stiffness what might you be concerned about and how would you investigate this further?
Meningitis Lumbar puncture= high protein, low glucose, lymphocytosis MRI scan- leptomeningeal enhancement
37
Where does spinal cord end
L1-2
38
Where to do LP
L3-4 intervertebral space
39
Results of lumbar puncture for viral infection
``` Clear appearance Normal to high protein Normal glucose High WCC and lymphocytes Negative culture ```
40
Results of lumbar puncture for bacterial infection
``` Cloudy appearance High protein Low glucose High WCC and neutrophils Positive bacterial culture ```
41
Types of TB that can occur
``` Pulmonary TB TB meningitis Pericardial TB Disseminated/ military TB Cutaneous TB affecting the skin ```
42
Antibiotic choice- staph aureus cellulitis
Flucloxacillin
43
How do penicillins work
Cell wall synthesis inhibitor
44
What are beta lactams
Pencillins and cephalosporins
45
Antibiotic choice- strep skin infection
Benzylpenicillin or flucloxacillin
46
Penicillin allergy- skin infections
Tetracyclines- doxycycline Carbapenem- meropenem Cephalosporin- ceftriazone
47
Antibiotic choice- strep pneumoniae CAP
Penicillin- amoxicillin Macrolide- erythromycin, clarithromycin 5 days or 7-10 days depending on severity
48
Antibiotic choice- atypical pneumonia
Doxycycline (broad spectrum) Macrolides- erythromycin, clarithromycin Fluoroquinolones- ciprofloxacin
49
Mechanism of action of fluroquinolones
Inhibits DNA gyrase- targets DNA
50
Mechanism of action of macrolides
Erythromycin, clarithromycin, azithromycin | Protein synthesis disruption - inhibit 50s ribosome unit
51
Antibiotic choice- MRSA
Resistant to beta lactams due to modification of pencillin-binding protein Instead use glycopeptides- vancomycin, teicoplanin Or gentamicin (aminoglycosides)
52
How do aminoglycosides work
Target protein synthesis | Inhibit 30s ribosome subunit
53
Abx for E coli gastroenteritis?
None As use of abx increases risk of haemolytic uraemic syndrome (vomiting, bloody diarrhoea, abdominal cramps)- E Coli 0157, shiga toxin
54
A man presents with severe vomiting. Earlier in the day he re-heated rice Cause?
Bacillus cereus - causes vomiting within 6 hrs Diarrhoea after 6hrs
55
Gastroenteritis- severe- Antibiotic choice-
Ciprofloxacin | Azithromycin
56
Antibiotic choice- Salmonella typhi
IV ceftriaxone or azithromycin
57
Antibiotic choice- profuse diarrhoea caused by C difficile
Metronidazole PO or vancomycin on second episode
58
Antibiotic choice- visceral infection or peritonitis- eg spleen abscess
co-amox or cipro or aminoglycoside eg gentamicine + anaerobic cover- metronidazole If severe infection or penicillin allergy- carbapenem
59
What are carbapenems
Cell wall synthesis inhibitors Very broad spectrum including anaerobes Safe in penicillin allergies
60
Antibiotic choice- HSV- encephalitis
IV acyclovir
61
Antibiotic choice- endocarditis
Strep viridans- benzylpenicillin +/- gentamicin Enterococci- amox +/- gent
62
Antibiotic choice- endocarditis in IVDU
Likely staph aureus as a cause- flucloxacillin | Consider bacillus cereus as a cause too
63
Antibiotic choice- sepsis
Meropenem (stat dose) (carbapenem=targets cell wall-beta lactam ring)
64
Antibiotic choice- Exacerbations of chronic bronchitis
Amoxicillin or tetracycline or clarithromycin
65
Antibiotic choice- Pneumonia possibly caused by atypical pathogens
Clarithromycin
66
Antibiotic choice- LUT
Trimethoprim or nitrofurantoin | Severe- IV co amoxiclav
67
Antibiotic choice- acute pyelonephritis
Broad spec cephalosporin or quinolone
68
Antibiotic choice- throat infections
Phenoxymethylpenicillin If allergic-erythromycin alone
69
Antibiotic choice- chlamydia
Doxycline or azithromycin
70
Antibiotic choice- gonorrhoea
IM ceftriazone
71
Antibiotic choice- bacterial vaginosis
Oral or topical metronidazole or topical clindamycin
72
Aminoglycosides-examples and side effects
Nephrotoxicity Ototoxicity Gentamicin
73
Tetracyclines- examples and side effects
Discolouration of teeth, photosensitivity- tell pt to wear sunscreen Oesophagitis and swallowing problems Doxycycline
74
Clindamycin- side effects
Common cause of C diff
75
Macrolides- examples and side effects
``` Erythromycin, clarithromycin, azithromycin Nausea esp erythromycin P450 inhibitor Prolonged QT Interferes with warfarin/ INR ```
76
What antibiotic is commonly associated with C difficile infection
Clindamycin
77
Vaccinations to avoid in HIV pts
``` Live attenuated vaccines- BCG MMR oral polio yellow fever oral typhoid Influenza- intranasal ```
78
Ix of choice for asymptomatic chlamydia pts
NAAT Male- first pass urine Female- vulvovaginal swab
79
Fever on alternating days, recent travel...
Malaria
80
Legionella typically colonises where..
Air-conditioning systems | Foreign holidays
81
Atypical pneumonia- legionella- diagnosis?
Urinary antigen test
82
Antibiotic choice- pregnant lady with symptomatic UTI
First line- nitrofurantoin but avoid near term Second line- amoxicillin or cefalexin TRIMETHOPRIM IS TERATOGENIC IN 1ST TRIMESTER JUST AVOID IT ALTOGETHER
83
Antibiotic choice- campylobacter
Clarithromycin
84
Antibiotic choice- pneumonia secondary to influenza
Classically caused by staph aureus | Flucloxacillin
85
Pneumonia in an alcoholic
Klebsiella pneumoniae
86
Green offensive chronic ulcer in diabetic pt
Pseudomonas
87
Infectious mononucleosis classic triad
sore throat, pyrexia and lymphadenopathy
88
Antibiotic choice- animal bite
Co-amoxiclav
89
Antibiotic choice- meningitis
Benzyl – P – enicillin --> Pre-hospital treatment (e.g. GP) Cefo – T – axime --> T - reatment Ci – Pro– floxacin --> Pro - phylaxis
90
Antibiotic choice- chlamydia
doxycycline
91
Antibiotic choice- gonorrhoea
IM ceftriaxone

EXAM PREP- YR 3 (4 decks)

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