MedEd Flashcards
(154 cards)
1
Q
what sort of virus is HIV
A
retrovirus (+sense RNA)
2
Q
which continent has a high prevalence of HIV
A
africa
3
Q
what is the life cycle of HIV
A
1 Attachment/Entry
2 Reverse Transcription of RNA and DNA Synthesis
3 Integration
4 Viral Transcription & Viral Protein Synthesis
5 Assembly & Release of Virus
6 Maturation
→ Reduction in CD4 cell count
4
Q
how can HIV be transmitted
A
sexual contact pregnancy, childbirth, breastfeeding IVDU occupational exposure blood tranfusion or organ transplant
5
Q
how is HIV not transmitted
A
air/water
insects or pets
faecal-oral route
6
Q
what are the three stages of HIV
A
1 primary infection
2 asymptomatic phase
3 AIDS
7
Q
what are features of primary infection in HIV
A
transient illness of 2-6wks post exposure
non-specific symptoms such as fever, fatigue, malaise
maculopapular rash
lymphadenopathy
8
Q
what are features of the asymptomatic phase in HIV
A
persistent generalised lymphadenopathy
constitutional symptoms
CD4<400 (mild immunosuppression)
9
Q
what are constitutional symptoms of HIV
A
fever, night sweats, diarrhoea, weight losss
10
Q
what defines AIDS
A
CD4 <200
11
Q
what are features of AIDS in HIV
A
CD4<200 opportunistic infections (oral candida, herpes zoster, tinea
12
Q
how long does it take for HIV infection to progress to AIDS
A
8-10yrs
13
Q
what commonly is a precipitant to HIV
A
unprotected sex
Eye
-CMV retinitis - mozerella pizza sign
14
Q
what are CNS signs + infections in HIV
A
- HAND - subcortical dementia
- encephalopathy
- toxoplasma gondii
- cryptococcal meningitis
- CMV encephalitis
15
Q
what are eye signs + infections in HIV
A
CMV retinitis - mozzeralla pizza sign
16
Q
what are features of subcortical dementia of HIV
A
motor slowing and loss of executive control
17
Q
what are pulmonary infections in HIV
A
TB mycobacterium CMV pneumonitis pneumocystis jiroveci pneumonia aspergillus, cryptococcus histoplasma
18
Q
what are tumours associated with HIV
A
lymphomas
kaposis sarcoma
SCC
19
Q
what gut signs + infections in HIV
A
anorexia, weight loss, HIV, enteropathy oral pain due to candidiasis EBV - oral hairy leucoplakia CMV oesophagitis, CMV colitis HSV ulcers Chronic diarrhoea Perianal disease, recurrent HSV uiceration, perianal warts
20
Q
what investigations are completed in suspected HIV
A
CD4 count
HIV RNA
HIV antibodies
21
Q
- A 27 year old IVDU complains of increasing shortness of breath that has been getting worse over the last three weeks accompanied by a dry cough. Her saturations are 94% and drop to 87% when walking. Her CD4 count is 150. CXR showed non-specific reticular interstitial shadowing.
Pneumocystis Jiroveci Haemophilus Influenzae Streptococcus Pneumoniae Mycobacterium Tuberculosis Cytomegalovirus
A
Pneumocystis Jiroveci
22
Q
- A 36 year old man who has sex with men comes to the GP with ulceration, bleeding and discomfort around his anus. He is trying alternative therapies to treat his HIV.
Cytomegalovirus Human Papillomavirus Human Herpes Virus 8 Herpes Simplex Virus Epstein-Barr Virus
A
Human Papillomavirus
23
Q
- A 31 year old lady on the HIV ward has white gunk all over her tongue that extends into her throat which can be peeled off. She says it’s very painful to swallow.
Candida albicans Epstein-Barr virus Herpes Simplex Virus Streptococcal throat infection Human herpes Virus 8
A
Candida albicans
24
Q
- A 43 year old HIV positive patient presents with weakness of his right leg, headaches, fever and confusion that have been getting worse for the last week. CT head shows multiple ring-enhancing lesions.
Plasmodium falciparum Neisseria meningitidis Toxoplasma gondii Herpes Simplex Encephalitis Pox virus
A
Toxoplasma gondii
25
5. A 47-year-old homeless man presents who is HIV-positive presents with purple popular lesions on his back and on his gums.
```
HHV-2
HHV-4
HHV-5
HHV-7
HHV-8
```
HHV-8
26
what is pneumocystis jiroveci
a yeast like fungus
27
what does pneumocystis jiroveci cause and in who
pneumonia in immunocompromised
28
what are features of pneumocystis jiroveci
fever
dry cough + exertional SOB
reduced O2 sats
bilateral crepitations
29
what is seen on CXR with pneumocystis jiroveci
bilateral perihilar interstitial shadowing
30
what is seen on CT chest with pneumocystis jiroveci
ground glass opacification
31
how is pneumocystis jiroveci diagnosed
sputum (to visualise organism)
| bronchoalveolar lavage
32
what is used to treat pneumocystis jiroveci
co-trimoxazole
33
how is HPV spread
sexual contact
34
what does HPV cause
genital warts
35
what types of HPV are associated with cervical cancer in women and anal cancer in men
16 & 18
36
what are features of HPV
bleeding, pain, change in bowel habit, itchy bum hole
37
what is used to treat HPV
chemo + radio
or
anorectal excision and colostomy
38
who is candida albicans common in
immunocompromised
39
what does candida allbicans cause
```
oral candidiasis
pneumonia
infective endocarditis
vaginal candidiasis (thrush)
urethritis
systemic candidiasis + sepsis
```
40
what features does oral candidiasis present with
pain on swallowing
| dysphagia
41
what is the treatment for oral condidiasis
nystatin suspension
42
what are features of vaginal candidiasis
discharge
red vagina
tenderness
43
what is the treatment for oral candidiasis
clotrimazole vaginal pessary
44
what is the treatment for systemic candidiasis + sepsis
flucanozole
45
what parts of the body does protozoa toxoplasma gondii affect
gut and then migrates to any part of body
46
how is toxoplasmosis transmitted
CATS
poorly cooked meat
soil contaminated vegetables
broken skin
47
what may reactivate toxoplasmosis
HIV
48
what are features of toxoplasmosis in immunocompromised patients
```
myocarditis
encephalitis
focal CNS signs
strokes
seizures
```
49
what tests are used for toxoplasmosis
high IgM in acute
50
what is the characteristic feature of toxoplasmosis on CT head
ring shaped contrast enhancing lesions
51
what causes kaposis sarcoma
HHV-8
52
what is kaposis sarcoma derived from
capillary endothelial cells or fibrous tissue
53
how does kaposis sarcoma (HHV8) present
papules or plaques on the skin and mucosa
54
how is HHV8 treated
optimise HAART
cryotherapy
chemo + radio
55
A 26 year old lawyer presents with a history of sharp tingling his lips followed by a painful ulcer at the side of his mouth. On examination he has cervical lymphadenopathy and a blister on his finger. What is the pathogen?
```
Varicella Zoster Virus
Epstein Barr Virus
Herpes Simplex Virus 1
Herpes Simplex Virus 2
Cytomegalovirus
```
Herpes Simplex Virus 1
56
What is the treatment HSV1
```
Rest at home, no treatment
Amoxicillin
Acyclovir
Ceftriaxone
Vancomycin
```
Acyclovir
57
A 19 year old university student present with a sore throat, headache, myalgia and coryzal symptoms. On examination he has cervical lymphadenopathy, enlarged exudative tonsils and splenomegaly. What is the most likely pathogen?
```
Varicella Zoster Virus
Epstein Barr Virus
Herpes Simplex Virus 1
Herpes Simplex Virus 2
Cytomegalovirus
```
Epstein Barr Virus
58
What is the treatment for EBV
```
Rest at home, no treatment
Amoxicillin
Acyclovir
Ceftriaxone
Vancomycin
```
Rest at home, no treatment
59
what are HHV1 and HHV2 AKA
HSV1 and HSV2
60
what are cardinal features of HSV1 and HSV2
HSV1 - oral ulcers, encephalitis
| HSV2 - genital ulcers
61
what is HHV3 AKA
VZV
62
what does VSV cause
chicken pox or shingles
63
what is HHV4 AKA
EBV (infectious mononucleosis, lymphoma)
64
what is HHV5 AKA
CMV
65
what does CMV and EBV cause
mononucleosis, hepatitis
66
what is HHV8 associated with
kaposis sarcoma
67
aetiology of HSV
virus becomes dormant following primary infection
| reactivation may occur with physical or emotional stress or when immunocompromised
68
where does HSV lay dormant
trigeminal or sacral root ganglia
69
how does HSV present
```
with recurrent infection or reactivation there is a prodrome of oral tingling and burning
vesicles appear (48hrs), ulcerate and crust over, complete healing in 10days
```
70
how does HSV1 present
Gingivostomatitis (inflammation or ulcers of gums and corners of the mouth)
herpetic whitlow - vesicle in finger
eczema herpeticum - HSV infection on eczematous skin
71
how does systemic infection by HSV1 present
fever, sore throat, lymphadenopathy, pneumonitis, hepatitis
72
how does herpes simplex encephalitis by HSV1 present
fever, fits, headaches, odd behaviour, dysphasia, hemiparesis
73
how does HSV2 present
genital herpes
74
what sort of lymphadenopathy is seen in HSV1
tender cervical lymphadenopathy
75
what sort of lymphadenopathy is seen in HSV2
inguinal lymphadenopathy
76
how is EBV spread
saliva or droplet (inhalation)
77
aetiology of EBV
predilection for B lymphocytes, incorporation of viral DNA into host DNA
78
how does EBV present
non specific symptoms such as fever, fatigue, malaise
sore throat,
79
what is seen on examination of EBV - infectious mononucleosis
inflamed tonsils with exudates
cervical lymphadenopathy
splenomegaly, hepatomegaly (jaundice)
80
how is EBV (infectious mononucleosis) diagnosed
monospot test for heterophile antibodies
| throat swab
81
when does IgG against EBNA present
6-12wks post onset of symptoms
82
What serological profile would you expect to see in a chronic Hepatitis B carrier?
1 HBsAg –, anti-HBc +, anti-HBs +, IgM anti-HBc –
2 HBsAg +, anti-HBc +, anti-HBs –, IgM anti-HBc +
3 HBsAg –, anti-HBc –, anti-HBs –
4 HBsAg +, anti-HBc +, anti-
HBs –, IgM anti-HBc –
5 HBsAg –, anti-HBc –, anti-HBs +
4 HBsAg +, anti-HBc +, anti-
| HBs –, IgM anti-HBc –
83
what is raised in acute infection (serology)
```
HBsAg (antigen)
IgM antiHBc (acute)
```
84
what increases overtime with infection (serology)
total anti-HBc
85
what is raised in chronic infection (serology)
anti-HBs
86
what is raised long term in chronic infection (serology)
HbsAg (antigen)
| total anti-HBc
87
what is HbsAg found in
acute or chonic INFECTION
88
what is anti-HBs found in
recovery + immunity to HBs or successful vaccination
89
what is total anti-HBc found in
previous or ongoing infection
90
what is IgM anti-HBc found in
acute infection
91
what does HBsAg –, anti-HBc +, anti-HBs +, IgM anti-HBc – indicate
previous infection, immune
92
what does HBsAg +, anti-HBc +, anti-HBs –, IgM anti-HBc + indicate
acute infection
93
what does HBsAg –, anti-HBc –, anti-HBs – indicate
susceptible
94
what does HBsAg +, anti-HBc +, anti-HBs –, IgM anti-HBc – indicate
chronic infection
95
what does HBsAg –, anti-HBc –, anti-HBs + indicate
vaccinated
96
An 70 year old man has been in hospital for the past two weeks for a severe pneumonia. He develops bloody diarrhoea, colitis, and a reduced urine output. He has a raised CRP, WCC and a low albumin.
```
Campylobacter
C. difficile
Bacillus cereus
E. coli
Vibrio cholera
```
C. difficile
97
An 18 year old girl on her gap year comes back from her travels, presenting to hospital with profuse diarrhoea of rice water appearance. There is no blood. She is shocked.
```
Entamoeba histolytica
Staph aureus
Bacillus cereus
E. coli
Vibrio cholera
```
Vibrio cholera
98
A man presents suffering with bloody, foul smelling diarrhoea. He attended a barbeque earlier in the day where he suspects he ate undercooked chicken. He has a fever and severe abdominal pain.
```
Campylobacter
Shigella
Bacillus cereus
E. coli
Salmonella
```
Campylobacter
99
what causes diarrhoea
```
s aureus
vibrio cholera
e coli
bacilus cereus
campylobacter
c difficile
salmonella
```
100
what is the mneumonic for causes of dysentry
CHESS
```
Campylobacter ? C difficile
Haemorrhagic e coli
Entamoeba histolytica
Shigella
Salmonella
```
101
what can cause diarrhoea and dysentry
campylobacter
c difficile
salmonella
102
what are buzzwords for c diff infection
antibiotic use
103
what are buzzwords for s aureus infection
1-6hrs after eating
| lasts less than 12hrs
104
what are buzzwords for vibrio cholera infection
rice water diarrhoea
| poor sanitation
105
what are buzzwords for e coli
travellers diarrhoea
| leafy vegetables
106
what are buzzwords for b cereus
reheated rice
107
what can b cereus cause
cerebral abscess
108
what might cause salmonella
eggs, poultry
109
what causes campylobacter infection
uncooked poultry
110
what causes haemorrhagic e coli
leafy vegetables
111
what is haemorrhagic e coli (dysentry) followed by HUS called
EHEC (enterohemorrhagic Escherichia coli)
112
what is associated with entamoeba histolytica
poor sanitation
| tropical places
113
what is associated with shigella
person to person cont-cat
114
what is the management for infection causing no systemic signs
supportive therapy
no stool culture needed
115
what is the management for systemic illness (>39C or dehydration, visible blood, or lasting >2wks)
admit and give oral gluids
direct faecal smear, then culture
116
what management should be taken with infection associated with travel, recent Abx, rectal intercourse or raw seafood
culture & microscopy
117
what is indicated if polymorphs are seen on smear
campylobacter
e coli
shigella
118
what is indicated if no polymorphs are seen on smear
salmonella
e coli
c difficile
119
what organism can present with polymorphs or no polymorphs
e coli
120
what is indicated if parasites are found on smear
roundworms
tapeworms
flukes (schistosomiasis)
121
The same 18 year old gap year student with resolved diarrhoea has gone back to do more travelling. About a month later, she presents with high swinging fevers and general malaise. You suspect malaria. Which of the following would be your most useful investigation for diagnosis.
```
FBC
U&Es
ESR/CRP
ABG
Thick and thin blood film
```
Thick and thin blood film
122
A 5 year old child comes home from nursery complaining of feeling like she needs to throw up, and isn’t hungry. A couple of days later a rash develops on her trunk, palms and soles of her feet, which is extremely itchy. What is the most likely causative organism?
```
Herpes virus 1
Herpes virus 2
Herpes virus 3
Herpes virus 4
Herpes virus 5
```
Herpes virus 3
123
A 70 year old man presents developing a rash across one side of his trunk which is painful and tingling, preceded by a headache and a fever. He had the chickenpox as a child. What is the most likely diagnosis.
```
Second episode of chickenpox
Herpes simplex virus infection
Shingles
Contact dermatitis
Fungal infection
```
shingles
124
how does influenza present
2-3days post exposure
non-specific symptoms such as fever, fatigue, malaise
sore throat, headache, unproductive cough
125
how is influenza diagnosed
based on clinical features + history
126
what are DDx for influenza
common cold
streptococcal pharyngitis
meningitis
127
how is influenza managed
supportive
```
or antivirals (oseltamivir) IF
>65yrs
pregnant
diabetes
immunosuppressed
```
128
what causes malaria
plasmodium protozoa
129
what transmits malaria
female anopheles mosquitos
130
what is protective against malaria
G6PD
| sickle cell trait
131
how does malaria present
```
1 cold stage <1hr
-shivering
2 hot stage (2-6hrs)
-41 degrees, N+V
3 sweats
-as temperature falls
```
132
what are signs of falciparum malaria infection
anaemia, jaundice, hepatosplenomegaly
| no rash, lymphadenopathy
133
what are complications of falciparum malaria infection
anaemia + thrombocytopenia
134
how is malaria diagnosed
thin and thick blood films
135
what does thin blood film look for
differentiates types of parasites
136
what does thick blood film look for
parasites in the blood
137
how is malaria treated
chloroquinine
138
what is HHV3
VSV
139
what does VZV cause
chickenpox
| shingles
140
what is chickenpox
a contagious febrile illness characterised by crops of blisters at various stages
141
how long is chickenpoxs incubation period
11-21days until signs or symptoms
142
how long is chickenpox infectious for
4 days BEFORE rash UNTIL all lesions have scabbed over
143
what does VZV lay dormant after infection
in trigeminal or sacral dorsal root ganglia
144
how does chickenpox present
prodrome of fatigue, fever, nausea, anorexia
OE
-fever
-rash (small erythematous macules which progress to papules and then develop crusts)
145
who is chickenpox common in
children
146
how do adults present with chickenpox
a more prolonged fever and a more widespread rash
147
how is a diagnosis of chickenpox or shingles made
clinical history + examination
148
what is the management of chickenpox in a healthy child
symptomatic and supportive treatment
149
what is the management for chickenpox or shingles in a adolescent or immunocompetent adult
oral aciclovir
150
what is the management for chickenpox or shingles with complications
admit to hospital
| IV aciclovir
151
what complications are associated with chickenpox
DIC
pneumoitis
ataxia
152
what is shingles
reactivation of VSV which was dormant in dorsal root ganglia
153
how does shingles present
prodrome of abnormal sensation + pain in dermatomal distribution
then a unilateral rash, with vesicular lesions which crust over in a week and heal in 3 weeks
154
what is neuritis
neuralgic pain over the same area
| associated with shingles
