Mercy Juma

Question 1

Clinical presentation of acute hepatitis

Answer 1

Acute hepatitis can be asymptomatic, muscle and joint pain, fever, nausea and vomiting, fatigue, malaise, anorexia, abdominal pain, dark urine, pale, grey-coloured poo, itchy skin, jaundice.

Question 2

Clinical presentation of chronic hepatitis

Answer 2

splenomegaly, spider angiomas in skin, redness of palms, abdominal ascites, coagulopathy, jaundice, hepatic encephalopathy.

Question 3

5 ddx for ejection systolic murmur

Answer 3

o	Problem with blood flow- thyrotoxicosis, pregnancy, anaemia
o	Aortic stenosis
o	Pulmonary stenosis
o	Aortic coarctation (narrowing)
o	Hypertrophic cardiomyopathy

Question 4

How is HIV detected in patients

Answer 4

o ELISA test followed by a western blot- works best at identifying chronic HIV infection. False negatives in the weeks to months after initial infection as antibodies aren’t produced quickly.
o Viral load: blood test, used in monitoring or to detect early HIV infection. RT-PCR, then branched DNA assay to amplify the signal, then nucleic acid sequence based amplification assay are the 3 steps.

Question 5

5 types of malaria

Answer 5

falciparum, vivax, malariae, ovale, knowlesi

Question 6

describe the temp variation between the types of malaria parasite

Answer 6

o Vivax and ovale you get a temperature spike every 36h
o Falciparum random fevers
o Malariae fever occurs every 72hrs
o Knowlesi fever spikes every 48h

Question 7

3 types of parasite

Answer 7

protozoa
helminths
ectoparasites

Question 8

MOA and side effects of lumefantrine

Answer 8

MOA: lumefantrine inhibits the formation of beta-hematin by forming a complex with hemin and inhibits nucleic acid and protein synthesis.

Side effects: abdominal pain, appetite decrease, cough, diarrhoea, dizziness, abnormal gait, headache, nausea, palpitations, QT interval prolongation, skin reactions, drowsiness, angioedema, toxicity in animal pregnancy studies, avoid breast feeding for 1 week after last dose.

Question 9

MOA of artemether

Answer 9

Interacts with heme or ferrous ions in the parasitic vacuole resulting in the generation of cytotoxic radials.

Question 10

5 options for prophylaxis of malaria

Answer 10

Atovaquone + proguanil
Chloroquine
doxycycline
mefloquine
primaquine

Question 11

What is AIDs?

Answer 11

o Acquired immunodeficiency syndrome

o CD4<200cells/mm and development of certain opportunistic infections

Question 12

Px of TB

Answer 12

cough, sputum, malaise, weight loss, night sweats, pleurisy, haemoptysis, plural effusion

Question 13

Px of cryptococcal meningitis

Answer 13

fever, headache, altered sensorium neck stiffness

Question 14

Tx of TB

Answer 14

isoniazid

azithromicin

Question 15

Tx of cryptococcal meningitis

Answer 15

amphotericin then fluconazole

Question 16

Px of toxoplasmosis

Answer 16

flu-like symptoms e.g. high temp, aching muscles, tiredness, nausea, sore throat, swollen glands

Question 17

Tx of toxoplasmosis

Answer 17

pyrimethamine then sulfadiazine and leucovorin

Question 18

Px of PCP

Answer 18

fever, cough, difficulty breathing, chest pain, chills, fatigue, SOB on exertion

Question 19

Tx of PCP

Answer 19

co-trimoxazole or pentamidine isethionate or prednisolone

Question 20

5 clinical features of HIV infection

Answer 20

o	Raised temperature 
o	Sore throat
o	Body rash 
o	Tiredness 
o	Joint pain 
o	Muscle pain 
o	Lymphadenopathy 
o	Weight loss
o	Chronic diarrhoea
o	Night sweats
o	Skin problems
o	Recurrent infections
o	Serious life-threatening illness

Question 21

Principles of antiretroviral therapy

Answer 21

2x NRTIs + 1 NNRTI, protease inhibitor or integrase inhibitors

Question 22

3 examples of NRTIs

Answer 22

tenofovir
emtricitabine
zidovudine
abacavir

Question 23

example of NNRTI

Answer 23

doravirine

Question 24

example of protease inhibitor

Answer 24

atazanavir

Question 25

example of integrase inhibitor

Answer 25

raltegravir

Question 26

2 drugs involved in PrEP

Answer 26

tenofovir and emtricitabine

Question 27

3 drugs in PEP

Answer 27

Emcitrabine, tenofovir and raltegravir.

Question 28

MOA of co-trimoxazle

Answer 28

sulfamethoxzole- inhibits bacterial dihydrofolic acid synthesis which is necessary for the production of purines and pyramidines. Trimethoprim- reversible inhibitor of dihydrofolate reductase, necessary for the biosynthesis of bacterial nucleic acids, thus having bactericidal activity.

Question 29

Co-trimoxazole side effects

Answer 29

diarrhoea, electrolyte imbalance, fungal overgrowth, headache, nausea, skin reactions, vomiting, dyspnoea, fever, haemolytic anaemia, SLE