Infective Diseases Flashcards
(87 cards)
1
Q
Which vaccines are live attenuated?
A
- BCG
- MMR
- Oral polio
- Yellow fever
- oral typhoid
2
Q
What is Reiter’s Syndrome?
A
- uveatis
- arthritis
- sexual infection
3
Q
What are symptoms of chlamydia?
A
- dysuria
- frequency
- discharge
- lymphadenopathy
- ulcers
- warts
4
Q
What antibiotics do you give for chlamydia?
A
- doxycyline (NOT IF PREGNANT)
- azithromycin
5
Q
What investigation do you do for ?chlamydia or ?gonorrhoea?
A
- NAAT - 1st voice urine, triple swabs (cervical, vulvovaginal)
6
Q
What is your treatment for gonorrhoea?
A
- ciprofloxacin
- ceftriaxone with azithromycin
7
Q
What is HIV seroconversion?
A
Initial illness - sore throat, malaise, myalgia, diarrhoea, lymphadenopathy, mouth ulcers
8
Q
Why is HIV PCR repeated 4-weeks post-exposure?
A
It sometimes takes that long to become detectable. If negative at 4 weeks, repeat again at 12 weeks (ELISA looks for p24 antigen)
9
Q
How do you treat malaria?
A
Falciparum - artesunate or quinine
Ovale/vivax - chloroquine
10
Q
What can you give in malaria prophylaxis?
A
Doxycycline
Malarone
Methoquine
11
Q
What investigations do you do in TB?
A
CXR Sputum culture Bronchoscopy and lavage Ziehl-neelson stain Mantoux skin test
12
Q
What are the four drugs used to treat TB and their main side effects?
A
Rifampicin - red urine, hepatotoxicity
Ethambutol - optic neuritis
Isoniazid - peripheral neuropathy
Pyrazinomaide - hepatotoxicity
13
Q
What is the most common cause of a UTI?
A
E.coli
14
Q
Give the name of some organisms that cause UTIs
A
E.coli
Klebsiella
Proteus
15
Q
What would you want to do a first catch urine sample for?
A
Chlamydia or Gonorrhoea
Urethritis
16
Q
What is your first line treatment in a UTI?
A
Nitrofurantoin
Trimethoprim
17
Q
When do you not give nitrofurantoin?
A
poor renal function or last trimester
18
Q
When is it pointless to do a urine dipstick on someone?
A
Elderly ladies over 65
Catheterised patients
19
Q
What symptoms might someone with a UTI present with?
A
Dysuria Burning on passing urine Cloudy urine Frequency Incontinence
20
Q
What country doesn’t have a vaccination programme for Hepatitis B?
A
UK
21
Q
Give some differentials for raised ALT, AST and bilirubin with jaundice and mildly raised ALP and GGT.
A
Hep B, Hep C, glandular fever, alcohol, Hep A
22
Q
What is the best way to test liver function?
A
Clotting
23
Q
Which viral hepatitis is a DNA virus?
A
Hep B
24
Q
What are risk factors in the transmission of hepatitis B?
A
Blood and needle stick injuries
Sexually transmitted
Vertical transmission
Sharing razors or toothbrushes
25
How might a patient with viral hep B present?
Fever, jaundice, rigors and sweats
Joint pain
Dark urine, pale stools, bile and itching
Hepatosplenomegaly, spider naevi
Increased risk of hepatocellular carcinoma
26
What would you see in a screening test of someone who has been vaccinated against Hepatitis B?
HbsAb
27
HbsAg means...
Hep B surface antigen
| They have the active disease - either acutely or chronically, it may not appear immediately
28
What would you see in a hep B screen of someone who has chronic Hep B?
```
Surface antigen (HbsAg)
Core antibody (HbcAb)
```
29
What are the 4 stages of a Hep B infection?
Immune Tolerance - high levels of viral replication, low levels of immune system
Immune Clearance - high levels of immune reaction
Inactive Carrier Phase - virus levels decreased
Reactivation Phase - inflammation occurs, fibrosis develops
30
What treatments exist for Hep B?
Pegylated interferon-alpha 2a
| Nucleotide analogues: Tenofovir or Entecavir
31
When is the Hep B vaccine given in children of woman who have the virus?
1, 7 and 21 weeks
32
Is Hep C curable and what is the name of the drug class used?
Yes
Direct Acting Antivirals (DAAs)
Telaprevir, Boceprevir
33
What can you use in Hep B/C to see the progression of liver cirrhosis?
Fibroscan - USS of the liver, measures the 'stiffness'
34
What bloods tests confirm Hepatitis C?
Hep C antibody
| Hep C RNA
35
What are the main causes for Hep C transmission?
IVDU
Tattoos
Needle stick injuries, BBV
36
What are the most common genotypes of Hep C?
1 and 3
37
What are two essential questions to ask someone returning from travel with a fever?
Malaria prophylaxis?
| Unwell contact?
38
What does PCP stand for and what does it cause? Who is at risk?
Pneumocystis jiroveci pneumonia
Fungal infection
Occurs in people with immunocompromise (HIV)
39
What treatment do you give for PCP?
Co-trimoxazole (not clotrimazole which is used for fungal infections)
Investigations: bronchiolar lavage, throat swab, sputum culture
40
What bacteria causes TB?
Mycobacteria tuberculosis
41
What are risk factors for TB?
```
Overcrowding, poor housing, homelessness
Alcohol, diabetes
Chronic lung disease
Malnutrition
Immunosuppression, HIV
```
42
What differentials exist for cellulitis?
DVT + PE
| Necrotising fasciitis
43
What are your differentials for a blistering rash and how might you investigate?
Shingles, herpes simplex (type 1 - cold sores, type 2 - genital), varicella zoster
Ix: PCR HSV or VZ, viral swab (green), bacterial swab (black)
44
What test do you do to determine malaria count and type?
Malaria phylum
Thick and thin film
Thick - malaria diagnosis
Thin - determines the count and morphology
45
What is treponema pallidum and some key symptoms?
Syphylis
Mouth ulcers, penile ulcers, inguinal lymphadenopathy
Rash on trunk, palms and soles
'Snail track' buccal ulcers
Primary features - chancre - painless ulcer, non-tender lymphadenopathy
46
What is the biggest risk for Hepatitis E?
Raw or undercooked pork
| Wild boar, venison
47
What are red flags for necrotising fasciitis?
Worsening cellulitis with pain out of keeping with physical features
48
What are the two different types of necrotising fasciitis?
Type 1 - mixed anaerobes and aerobes
| Type 2 - strep pyogenes
49
What are complications of gonorrhoea in males and females?
Males - urethral stricture, epididymitis, salpingitis (infertility)
Females - bartholin's abscess, PID
Systemic complication - peri-hepatitis, reactive arthritis
50
What are the 4 subspecies of malaria?
P. falciparum
P. vivax
P. ovale
P. malariae
51
Give 5 symptoms of malaria
Severe headache
Fever
Hepatosplenomagaly
Haemolysis - jaundice, diarrhoea and vomiting
52
What is considered severe malaria?
>2%
53
Give 3 drugs you can give to treat malaria?
Quinine
Artesunate
Primaquine
54
Give the name of 3 malaria prophylactic drugs
Doxycycline
Malarone
Methoquine
55
What are some important respiratory conditions in which you should consider underlying HIV as a diagnosis?
```
PCP
TB
Kaposi's Sarcoma
Pneumonia
Cryptococcus
Toxoplasma
```
56
How is HIV transmitted?
```
Sexually
Vertically
Blood products
IV drug use
Needlestick injuries
```
57
What CD4 count is considered AIDS?
CD4<200
| Acquired Immune Deficiency Syndrome
58
What investigation is done for HIV?
ELISA - looks for antibody and antigen
Virus can take 2-3 weeks to develop so if negative, repeat 4 weeks later
Can also do CD4 and viral load to monitor disease
59
What is the chance a pregnant woman with HIV could pass the virus to her unborn child?
Without treatment 15-45%
With antiretroviral treatment the risk drops to below 5%
60
What is the name for the group of drugs used to treat HIV?
What is the usual combination given?
HAART
Highly Active Antiretroviral Therapy
2 NRTI (nucleoside reverse transcriptase inhibitors) + a protease inhibitor/non-NRTI
61
Give an example of a NRTI, PI and NNRTI
Tenofovir/Abacavir
Ritonavir
Nevirapine
62
What procedure should be done in pregnant woman with HIV to prevent transmission to the baby?
Caesarean
63
What is the difference between meningitis and meningococcal septicaemia?
Meningitis - inflammation of the meninges
| Meningococcal septicaemia - bacterial infection with neisseria meningitides
64
What are the 3 symptoms in meningism?
Photophobia
Neck stiffness
Headache
65
What is Kernig's and Brudzinski's sign?
Kernig's - inability to straighten leg while hips are flexed
| Brudzinski - flexion of the hip/or knee on neck flexion
66
A patient present with a non-blanching purpuric rash to A&E. What is your order of management?
What would you do if you were in the community?
Ceftriaxone 2-4mg IV
Blood cultures - do not delay treatment to do these
BenPen IM
67
What are indications to delay a LP in a patient with meningitis?
Severe sepsis, rash
Resp or cardiac compromise
Raised ICP risk
Thrombocytopenia or coagulopathy
68
What would you expect to see in a LP showing bacterial meningitis?
Polymorphs
High white cells
Turbid
Low glucose and raised protein
69
What is looked at in a lumbar puncture?
Cell types, white cell count, appearance, glucose, protein and gram stain
70
What would you expect to see in a LP showing viral meningitis?
Lymphocytes, high white cells, clear, normal glucose and protein
71
What are some common causative organisms of bacterial meningitis?
```
Neisseria meningitis
TB
H. influenza
Group B strep
Listeria
E. coli
```
(last 3 are common causes of neonate infection)
72
What is given to families in meningitis prophylaxis?
Ciprofloxacin
| Rifampicin
73
What are some common causes of viral meningitis?
Enterovirus
Herpes simplex
Varicella Zoster
74
What is your management of viral meningitis?
Acylovir if herpes
| Supportive - paracetamol, ibuprofen
75
A fever and new onset murmur is what until proven otherwise?
Endocarditis
76
What are the number and virus associated with genital warts and cervical cancer?
Genital herpes?
Genital Warts - HPV 6 and 11
Cervical Cancer - HPV 16 and 18
HSV - herpes simplex virus - 1 (cold sores) and 2 (genital)
77
What is the window for giving post-exposure prophylaxis in HIV exposure?
72-hour window
78
What are the 4 species of plasmodium that cause disease in humans? What cell types does it affect?
P. falciparum, p. vivax, p. ovale, p. malariae
| Hepatocytes, erythrocytes
79
What do seizures in malaria indicate?
Cerebral malaria
80
What complications can occur in malaria?
Hypoglycaemia
Acute renal failure
Respiratory distress
Severe anaemia
81
What vaccines are live attenuated?
BCG, MMR, oral polio, yellow fever, oral typhoid
82
Patients with a CD4 count lower than 200 should receive prophylactic treatment for what?
Co-trimoxazole for pneumocystis juroveci pneumonia
83
What laboratory tests are done to look at different sexually transmitted diseases
Urethral gonorrhoea and chlamydia – urine nucleic acid amplification test (NAAT)
Syphilis – VDRL (venereal disease research laboratory) and RPR (rapid plasma reagain)
84
What is the most common complication of measles?
```
Otitis media
Pneumonia – common cause of death
Encephalitis
Diarrhoea
Subacute sclerosing panencephalitis
Myocarditis
```
85
What drug therapy do you start in HIV?
Highly active antiretroviral theraphy (HAART)
2 Nucleotide reverse transcriptase inhibitors (NRTI) : 1 Non-nucleotide reverse transcriptase inhibitor (NNRTI or 1 Protease inhibitor (PI)
86
What is HIV and how does it replicate?
Retrovirus with double stranded RNA
It attaches to CD4 receptors on t-helped cells and inserts RNA into the host cells using reverse transcriptase. The DNA is then inserted into the host sequence and the viral DNA replicated.
87
What prophylactic treatments can be given to HIV patients and what are they for?
Co-trimoxazole - toxoplasmosis and PCP
Azithromycin - MAI
Pentamidine - PCP
Ganciclovir - active CMV
