MRCP 2 Flashcards
1
Q
Gram stain of actinomyces and Norcadia ?
A
Gram-positive rods that form fungus-like branched networks of hyphae-like filaments.
2
Q
Features of actinomyces israeli?
A
Gram-positive anaerobic bacteria from the Actinomycetaceae family.
causes oral/facial abscesses with sulphur granules in sinus tracts
May also cause abdominal mass
3
Q
Treatment of actinomyces?
A
Long-term antibiotic therapy usually with penicillin
Surgical resection is indicated for extensive necrotic
tissue, non-healing sinus tracts, abscesses or where biopsy is needed to exclude malignancy.
4
Q
Presentation of Norcadia?
A
typically causes pneumonia in immunocompromised patients
may also cause brain abscesses
5
Q
Causative organism of epiglottisi?
A
Haemophilus Influenzae B
6
Q
Thumb sign ?
A
Acute epiglottitis
7
Q
Steeple sign?
A
Croup
8
Q
Management of epiglottitis?
A
endotracheal intubation may be necessary to protect the airway
9
Q
Bloody diarrhoea + Long incubation ?
A
Amoebiasis
10
Q
Test for amoebiasis?
A
Hot stool test
11
Q
Treatment of amoebiasis?
A
Metronidazole + diloxanide furoate
a ‘luminal agent’ (to eliminate intraluminal cysts) is recommended usually as well e.g.
12
Q
Liver mass + content of ‘anchovy sauce’
A
Amoebiasis liver abscess
13
Q
Investigations in amoebiasis liver abscess?
A
Ultrasound
Serology ( positive in 95%)
14
Q
Management of amoebiasis liver abscess?
A
Metronidazole oral + luminal agent
15
Q
Three features of antrhax toxin?
A
protective antigen
oedema factor: a bacterial adenylate cyclase which increases cAMP
lethal factor: toxic to macrophages
16
Q
painless black eschar ( cutaneous malignant pustule) + marked oedema + GI bleeding
A
Anthrax
17
Q
Management of anthrax?
A
Ciprofloxacin
18
Q
Gram stain of anthrax?
A
Bacillus anthrax
Gram positive rod
19
Q
Antibiotic: exacerbation chronic bronchitis?
A
Amoxicillin
Or
Tetracycline
Or
Clarithromycin
20
Q
Antibiotic: Uncomplicated pneumonia?
A
Amoxicillin
(Doxcycline or clarithromycin if pen allergic)
If staph suspected cosider adding flucloxacillin
21
Q
Antibiotic: Pneumonia caused by atypicals?
A
Clarithromycin
22
Q
Antibiotic: HAP?
A
Within 5 days of admission: co-amoxiclav or cefuroxime
More than 5 days after admission: piperacillin with tazobactam OR a broad-spectrum cephalosporin (e.g. ceftazidime) OR a quinolone (e.g. ciprofloxacin)
23
Q
Antibiotic: Lower urinary tracrt infection?
A
Trimethoprim or nitrofurantoin.
Alternative: amoxicillin or cephalosporin
24
Q
Antibiotic: Acute pyelonephritis?
A
Broad-spectrum cephalosporin or quinolone
25
Antibiotic: Acute prostatitis?
Quinolone or trimethoprim
26
Antibiotic: Impetigo?
Topical hydrogen peroxide
Or oral flucloxacillin or erythromycin if widespread
27
Antibiotic: Cellulitis?
Flucloxacillin
(clarithromycin, erythromycin or doxycycline if penicillin-allergic)
28
Antibiotic: Cellulitis near nose and mouth ?
Co-amoxiclav (clarithromycin, + metronidazole if penicillin-allergic)
29
Antibiotic: Erysipelas?
Flucloxacillin* (clarithromycin, erythromycin or doxycycline if penicillin-allergic)
30
Antibiotic: Animal bite or human bite?
Co-amoxiclav (doxycycline + metronidazole if penicillin-allergic)
31
Antibiotic: Mastitis?
Flucloxacillin
32
Antibiotic: Throat infection?
Phenoxymethylpenicillin (erythromycin alone if penicillin-allergic)
33
Antibiotic: Sinusitis?
Phenoxymethylpenicillin
34
Antibiotic: Otitis Media?
Amoxicillin (erythromycin if penicillin-allergic)
35
Antibiotic: Otitis externa?
Flucloxacillin (erythromycin if penicillin-allergic)
36
Antibiotic: Gingivitis?
Metronidazole
37
Antibiotic: Gonorrohoea?
Intramuscular ceftriaxone
38
Antibiotic: Chlamydia?
Doxycycline or azithromycin
39
Antibiotic: Pelvic inflammatory disease?
Oral ofloxacin + oral metronidazole or intramuscular ceftriaxone + oral doxycycline + oral metronidazole
40
Antibiotic: Syphilus?
Benzathine benzylpenicillin or doxycycline or erythromycin
41
Antibiotic: Bacterial vaginosis?
Oral or topical metronidazole or topical clindamycin
42
Antibiotic: C-DIff?
First episode: oral vancomycin
Second or subsequent episode of infection: oral fidaxomicin
43
Antibiotic: Campylobacter?
Clarithromycin
44
Antibiotic: Ciprofloxacin?
Ciprofloxacin
45
Antibiotic: Shigellosis?
Ciprofloxacin
46
Antiviral: HSV or VZV ?
Aciclovir
47
Adverse effect of aciclovir?
Crystal nephropathy
48
Antiviral: CMV
Ganiciclovir
49
Adverse effect of ganiciclovir?
Myelosuppression
50
Antiviral: Chronic Hepatitis C
Ribiravin
51
Antiviral: RSV?
Ribiravin
52
Adverse effect of ribiravin?
Haemolytic anaemia
53
Antiviral: Influenza?
Amantidine
(also used in parkinsons)
54
Adverse effect of amantidine?
Confusion
Slurred speech
55
Antiviral: CMV?
Foscarnet
56
Adverse effect of foscarnet?
Nephrotoxicity, hypocalcaemia, hypomagnasaemia, seizures
57
Antiviral: Chronic hepatitis B & C, hairy cell leukaemia
Interferon alpha
58
Adverse effect of interferon alpha?
Flu-like symptoms, anorexia, myelosuppression
59
Antiviral: CMV retinitis in HIV?
Cidofovir
60
Adverse effect of cidofovir?
Nephrotoxicity
61
Cresecent sign?
Aspergilloma
62
Bacterial vaginosis criteria:
1. Thin, white homogenous discharge
2. Clue cells on microscopy: stippled vaginal epithelial cells
3. Vaginal pH > 4.5
4. Positive whiff test (addition of potassium hydroxide results in fishy odour)
63
Treatment of bacterail vaginosis?
Oral metronidazole
64
Differences between bacterial vaginosis and trichomonas?
White dischagre -- > BV
Green / yellow / frothy --> Trichomonas
Vulvovaginitis --> Trichomonas
Strawberry cervix --> Trichomonas
65
Pregnancy + Bacteial vaginosis?
Oral metrondizole
66
Management of bed bugs?
Topical hydrocortisone
Extermination
67
Gram stain of botulism?
gram positive anaerobic bacillus
68
Mechanism of botulism?
produces botulinum toxin, a neurotoxin which irreversibly blocks the release of acetylcholine
69
Features of botulism?
patient usually fully conscious with no sensory disturbance
FLACCID PARALYSIS
diplopia
ataxia
bulbar palsy
70
Management of botulism?
botulism antitoxin and supportive care
71
Who gets brucellosis?
Vets
Abattoir workers
72
Incubation of brucellosis?
2-6 weeks
73
Features of brucellosis?
non-specific: fever, malaise
hepatosplenomegaly
sacroiliitis: spinal tenderness may be seen
complications: osteomyelitis, infective endocarditis, meningoencephalitis, orchitis
leukopenia often seen
74
Diagnosis of brucellosis?
Rose Bengal plate test can be used for screening but other tests are required to confirm the diagnosis
Best test**** --> Serology
75
Treatment of brucellosis?
doxycycline and streptomycin
76
Causative organism of bubonic plague?
Yserinia pestis
77
Vector of the plague?
Fleas transmit the bacteria from rodents to humans via their bite
78
What are carbopenems@?
β-lactam antibiotics that are resistant to most β-lactamases.
Meropenem
Imipenem
79
Causative organism of cat scratch disease?
Bartonella
80
Features of cat scratch disease?
fever
history of a cat scratch
regional lymphadenopathy
headache, malaise
81
How is chicken pocks so infections ?
Infectious 4 days prior to rash
82
Incubation of chicken pocks?
21 days
83
Who should recieve varicella immunoglobulin?
Immunocompromised
Newborns
Others: check immunoglobulin levels
84
Who should receive varicella immunoglobulin?
Immunocompromised
Newborns
Others: check immunoglobulin levels
85
What is a common complication post chicken poxs?
Manifest as a single infected lesion/small area of cellulitis
Rare cases can have necrotising fascitis
invasive group A streptococcal soft tissue infections may occur resulting in necrotizing fasciitis
86
Features of foetal varicella syndrome?
skin scarring, eye defects (microphthalmia), limb hypoplasia, microcephaly and learning disabilities
87
Varicella exposure + < 20 weeks + non immunised?
given varicella-zoster immunoglobulin (VZIG)
88
Varicella exposure + >20 weeks + non immunised?
VZIG or antivirals (aciclovir or valaciclovir) should be given days 7 to 14 after exposure
89
>20 weeks Pregnant + Develops chicken poxs?
oral aciclovir should be given if the pregnant women is ≥ 20 weeks and she presents within 24 hours of onset of the rash
90
< 20 weeks Pregnant + develops chickenpox?
Oral aciclovir
91
What causes Chikungunya?
Alphavirus disease caused by infected mosquitoes
92
Dengue like symptoms + severe bone pain?
Chikungunya
93
Features of measles?
Prodrome: irritable, conjunctivitis, fever
Koplik spots: white spots ('grain of salt') on buccal mucosa
Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent
94
Features of mumps?
Fever, malaise, muscular pain
Parotitis ('earache', 'pain on eating'): unilateral initially then becomes bilateral in 70%
95
Features of rubella?
Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular
96
Causes of erythema infectiosum?
Parvovirus B19
97
Features of erythema infectiosum?
slapped-cheek syndrome'
Caused by parvovirus B19
Lethargy, fever, headache
'Slapped-cheek' rash spreading to proximal arms and extensor surfaces
98
Features of scarlet fever?
Fever, malaise, tonsillitis
'Strawberry' tongue
Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)
99
Causative organism of scarlet fever?
Group A haemolytic streptococci
100
Cause of hand foot and mouth disease?
coxsackie A16 virus
101
Features of hand foot and mouth disease?
Vesicles in the mouth and on the palms and soles of the feet
102
Complications of chlamydia?
epididymitis
pelvic inflammatory disease
endometritis
increased incidence of ectopic pregnancies
infertility
reactive arthritis
perihepatitis (Fitz-Hugh-Curtis syndrome)
103
Investigation for chlamydia?
nuclear acid amplification tests (NAATs) are now the investigation of choice
104
Male and female test for chlamydia?
for women: the vulvovaginal swab is first-line
for men: the urine test is first-line
105
When is the ideal time to test for chlamydia?
2 weeks after exposure
106
Treatment of chlamydia?
Doxycycline 7 days
107
Pregnant + chlamdyia?
azithromycin, erythromycin or amoxicillin
108
Contact tracing for men for chlamydia?
4 weeks
109
Contact tracing for women with chlamydia?
6 weeks
110
Toxin produces by clostridium perfringens?
Alpha toxin
Causesgas gangrene and haemolysis
111
Toxin produced by Clostrium difficle?
Exotoxin + Cytotoxin
112
Toxin produced by clostrium tetani?
exotoxin (tetanospasmin) that prevents the release of glycine
Renshaw cells in the spinal cord causing a spastic paralysis
113
Management of croup?
General management:
oral dexamethasone (0.15mg/kg) to all children regardless of severity
EMERGENCY MANAGEMENT:
high-flow oxygen
nebulised adrenaline
114
Most common cause of protozol diarrhoea in UK ?
Cryptosporidium
115
Features of cryptococcus?
watery diarrhoea
abdominal cramps
fever
Immunocompromised: entire gastrointestinal tract may be affected resulting in complications such as sclerosing cholangitis and pancreatitis
116
Investigation for cryptococcus?
Modified ziehl neilson staining
Demonstrates red cysts
117
Management of cryptococcus?
Largley supportive
nitazoxanide may be used for immunocompromised patients
rifaximin is also sometimes used for immunocompromised patients/patients with severe disease
118
What is the causative organism of cutaneous larva migrans?
Ancyclostoma braziliense.
Hook worm
119
Management of cutaneous larva migrans?
albendazole
or
ivermectin.
120
Congential CMV infection?
pinpoint petechial 'blueberry muffin' skin lesions, microcephaly, sensorineural deafness, encephalitiis (seizures) and hepatosplenomegaly
121
Glandular fever features + no atyical lymphocytes + negative EBV
CMV mononucleosis
Can occur in immunocompetent people
122
Features of CMV retinitis?
common in HIV patients with a low CD4 count (< 50)
presents with visual impairment e.g. 'blurred vision'.
Fundoscopy shows retinal haemorrhages and necrosis, often called 'pizza' retina
123
Management of CMV retinitis?
IV ganciclovir is the treatment of choice
124
What are the viral haemorrhagic fevers?
yellow fever
Lassa fever
Ebola
Dengue fever
125
How is dengue fever transmitted?
Aedes aegypti mosquito
126
Features of dengue fever?
fever
headache (often retro-orbital)
myalgia, bone pain and arthralgia ('break-bone fever')
pleuritic pain
facial flushing (dengue)
maculopapular rash
haemorrhagic manifestations e.g. positive tourniquet test, petechiae, purpura/ecchymosis, epistaxis
127
What are dengue warning signs? - Meaning it should be classed as severe?
abdominal pain
hepatomegaly
persistent vomiting
clinical fluid accumulation (ascites, pleural effusion)
128
What is features of severe dengue haemorrhagic fever?
disseminated intravascular coagulation (DIC) resulting in:
thrombocytopenia
spontaneous bleeding
Dengue shock syndrome
129
Diagnostic tests for dengue fever?
serology
nucleic acid amplification tests for viral RNA
NS1 antigen test
130
What is the causative organism of diptheria?
Corynebacterium diphtheriae
131
Features of diptheria?
'diphtheric membrane' on tonsils caused by necrotic mucosal cells
132
Fetures of diptheria?
Recent visitors to Eastern Europe/Russia/Asia
Sore throat with a 'diphtheric membrane' - grey
Pseudomembrane on the posterior pharyngeal wall
bulky cervical lymphadenopathy
May result in a 'bull neck' appearanace
neuritis e.g. cranial nerves
Heart block
133
Investigations for diptheria?
Tellurite agar
Loeffler's media
134
Management of diphtheria?
intramuscular penicillin
diphtheria antitoxin
135
What is the only non-double stranded DNA virus?
Parvovirus
136
Cause of molloscum contagiosum?
Pox virus
137
Example of polyoma virus?
JC virus
Causes progressive multifocal leukoencephalopathy)
138
What are the DNA viruses?
HHAPPPPy!
Hepadna
Herpes
Adeno
Pox
Parvo
Papilloma
Polyoma
139
What causes typhoid and paratyphod respectively?
Salmonella typhi
Salmonella paratyphi
140
Features of enteric fever?
Initially systemic upset
Relative bradycardia
Abdominal pain, distension
Constipation: although Salmonella is a recognised cause of diarrhoea, constipation is more common in typhoid
Rose spots: present on the trunk in 40% of patients, and are more common in paratyphoid
141
How to differentiate between typhoid and paratyphoid?
Rose spots --> more common in paratyphoid
Constipation more common in typhoid
142
Definition of travellers diarrhoea?
3 loose to watery stools in 24 hours
with / without:
one of more of abdominal cramps, fever, nausea, vomiting or blood in the stool
143
Gastroenteritis:
Common amongst travellers
Watery stools
Abdominal cramps and nausea
E coli
144
Prolonged, non-bloody diarrhoea
Giardiasis
145
Profuse, watery diarrhoea
Severe dehydration resulting in weight loss
Not common amongst travellers
Cholera
146
Bloody diarrhoea
Vomiting and abdominal pain
Shigella
147
Severe vomiting
Short incubation period
Staph aureus
148
A flu-like prodrome is usually followed by crampy abdominal pains, fever and diarrhoea which may be bloody
May mimic appendicitis
Complications include Guillain-Barre syndrome
Campylobacter
149
Gradual onset bloody diarrhoea, abdominal pain and tenderness which may last for several weeks
Amoebiasis
150
Gastroenteritis incubation: 1-6 hours
Staphylococcus aureus
Bacillus cereus*
151
Gastroenteritis incubation: 12-48 hours
Salmonella
Escherichia coli
152
Gastroenteritis incubation: 48-72 hours:
Shigella, Campylobacter
153
Gastroenteritis incubaton > 7 days
Giardiasis, Amoebiasis
154
What type of organism is giardiasis?
Flagellate protozoan Giardia lamblia
155
Features of giardiasis?
often asymptomatic
NON BLODDY
steatorrhoea
bloating, abdominal pain
lethargy
flatulence
weight loss
malabsorption and lactose intolerance can occur
156
Best test for giardiasis?
stool microscopy for trophozoite and cysts: sensitivity of around 65%
**Best test**stool antigen detection assay: greater sensitivity and faster turn-around time than conventional stool microscopy methods
157
Treatment of giardiasis?
Metronidazole
158
Features of gonorrhea in men?
males: urethral discharge, dysuria
159
Features of gonorrhea in women?
females: cervicitis e.g. leading to vaginal discharge
160
What is the treatment of gonorrhea?
IM ceftriaxone
161
Patient needle phobic: Treatment of gonorrhea?
oral cefixime 400mg (single dose) + oral azithromycin 2g (single dose)
162
Complications of gonorrohea infection?
Disseminated gonorrhea infection
Gonnoccocal infection
Later complications include septic arthritis, endocarditis and perihepatitis (Fitz-Hugh-Curtis syndrome)
163
Features of disseminated gonorrhea infection?
tenosynovitis
migratory polyarthritis
dermatitis (lesions can be maculopapular or vesicular)
164
Is hand foot and mouth related to cattle
No nothing to do with it
165
How do you acquire a strongyloides infection?
Larvae are present in soil and gain access to the body by penetrating the skin
166
Features of strongyloides infection?
Diarrhoea, abdominal pain, papulovesicular lesions
larva currens: pruritic, linear, urticarial rash, if the larvae migrate to the lungs a pneumonitis similar to Loeffler's syndrome
167
Treatment of strongyloides?
Bendazoles
Or Invermetacin
168
Features of Enterobius vermicularis infection?
Thread worm
include perianal itching, particularly at night; girls may have vulval symptoms
169
How do you diagnose enterobius vermicularis?
Diagnosis may be made by the applying sticky plastic tape to the perianal area and sending it to the laboratory for microscopy to see the eggs
170
What is hook worm called?
Ancylostoma duodenale
Necator americanus
171
Features of hook worm infection?
Larvae penetrate skin of feet; gastrointestinal infection → anaemia
Thin-shelled ova
172
Treatment of hook worm?
Bendazoles
173
Features of loa loa?
Causes red itchy swellings below the skin called 'Calabar swellings', may be observed when crossing conjunctivae
174
What is the transmission of loa loa?
Mango fly
Deer fly
175
Treatment of loa loa ?
Diethylcarbamazine
176
Nematode infection caught from eating pork?
Trichinella spiralis
177
Features of Trichinella spiralis infection?
Features include fever, periorbital oedema and myositis (larvae encyst in muscle)
178
Treatment of Trichnella spiralis?
Bendazoles
179
Nematode that causes blindness?
Onchocerca volvulus
Causes river blindness
180
How is onchocerca volvulus spread?
Female blackflies
181
Features of onchocerca volvulus?
Features include fever, periorbital oedema and myositis (larvae encyst in muscle)
182
Treatment of onchocerca volvulus?
Ivermetacin
183
Nematode that causes elphantiasis?
Wuchereria bancrofti
184
How is Wuchereria bancrofti spread?
Female mosquito
185
Treatment of Wuchereria bancrofti
Diethylcarbamazine
186
visceral larva migrans and retinal granulomas
Toxocara canis (dog roundworm)
VISCious dogs → blindness
187
Tape worm acquired from dog faecus and eggs
Echinococcus granulosus
188
Tapeworm acquired from undercooked pork?
Taenia solium
189
Causes 'swimmer's itch' - frequency, haematuria. Risk factor for squamous cell bladder cancer
Schistosoma haematobium
190
Treatment of schistosoma?
Praziquantel
191
How is hepatitis B acquired?
exposure to infected blood or body fluids,
including vertical transmission from mother to child.
192
Features of hepatitis B infection?
fever, jaundice and elevated liver transaminases.
193
Complications of hepatitis B infection?
chronic hepatitis (5-10%). 'Ground-glass' hepatocytes may be seen on light microscopy
fulminant liver failure (1%)
hepatocellular carcinoma
glomerulonephritis
polyarteritis nodosa
cryoglobulinaemia
194
How do you check response of hepatitis vaccine?
Anti-HBs
195
What does an anti-HBs level of >100 indicate?
Indicates adequate response, no further testing required. Should still receive booster at 5 years
196
What does an anti-HBs level of 10-100 indicate?
Suboptimal response - one additional vaccine dose should be given.
If immunocompetent no further testing is required
197
What does an anti-HBs level of < 10 indicate?
Non-responder. Test for current or past infection. Give further vaccine course (i.e. 3 doses again) with testing following. If still fails to respond then HBIG would be required for protection if exposed to the virus
198
Two time complete course of heptatitis vaccine + still not responding. What is the management?
HBIG if exposured
199
What is the treatment of hepatitis B ?
tenofovir, entecavir and telbivudine (a synthetic thymidine nucleoside analogue)
Old medication: pegylated interferon-alpha
200
Who gets hepatitis C?
Intravenous drug uses
201
Complications of hepatitis C?
rheumatological problems: arthralgia, arthritis
eye problems: Sjogren's syndrome
cirrhosis (5-20% of those with chronic disease)
hepatocellular cancer
cryoglobulinaemia: typically type II (mixed monoclonal and polyclonal)
porphyria cutanea tarda (PCT)
membranoproliferative glomerulonephritis
202
Is breast feeding contraindicated in hepatitis C?
No
203
Can you breast feed with hepatitis B
Yes
204
What type of virus is hepatitis C?
hepatitis C is a RNA flavivirus
205
How is hepatitis C defined?
persistence of HCV RNA in the blood for 6 months.
206
What is the treatment for hepatitis C?
depends on the viral genotype - this should be tested prior to treatment
daclatasvir + sofosbuvir or sofosbuvir + simeprevir) with or without ribavirin are used
Interferon no longer used
207
Side effect of ribavirin?
Haemolytic anaemia, cough. Women should not become pregnant within 6 months of stopping ribavirin as it is teratogenic
208
Side effect of interferon?
flu-like symptoms, depression, fatigue, leukopenia, thrombocytopenia
209
What does Hepatitis D require?
Requires hepatitis B surface antigen to complete replication cycle
210
What is a hepatitis D co-infection?
Hepatitis B and Hepatitis D infection at the same time.
211
What is a heptatitis D super added infection?
A hepatitis B surface antigen positive patient subsequently develops a hepatitis D infection.
212
What has a worse prognosis: Co-infection of hepatitis D or superadded infection?
Superadded infection
213
Treatment for hepatitis D?
Interferon alpha
214
Women with new LFT rise and its hepatitis?
Hepatitis E
215
HSV: Oral lesion?
HSV1
216
HSV: Genital lesions ?
HSV2
217
What is the cut off for viral load in HIV +ve lady who is pregnant: C section vs vaginal?
vaginal delivery is recommended if viral load is less than 50 copies/ml at 36 weeks, otherwise caesarian section is recommended
218
What should be commenced before c section in HIV +ve woman?
zidovudine infusion should be started four hours before beginning the caesarean section
219
Neonate: Mothers HIV viral load < 50?
zidovudine is usually administered orally to the neonate if maternal viral load is <50 copies/ml.
220
Neonate: Mothers HIV viral load > 50?
ART should be used. Therapy should be continued for 4-6 weeks.
221
Breast feeding in HIV +ve?
No
222
HIV related CMV retinitis:
Cell count?
> 50
223
Appearance of CMV retinitis?
characteristic appearance showing retinal haemorrhages and necrosis
often called 'pizza' retina
224
Management of CMV retiniits?
IV ganciclovir
treatment used to be life-long but new evidence suggests that it may be discontinued once CD4 > 150 after HAART
alternative: IV foscarnet or cidofovir
225
Most common cause of HIV diarrhoea?
Cryptosporidium
226
Causes of HIV diarrhoea?
Cryptosporidium + other protozoa (most common)
Cytomegalovirus
Mycobacterium avium intracellulare
Giardia
227
Cause of kaposi sarcoma?
HHV-8 (human herpes virus 8)
228
What is the treatment regimen for HIV?
combination of at least three drugs, typically two nucleoside reverse transcriptase inhibitors (NRTI) and either a protease inhibitor (PI) or a non-nucleoside reverse transcriptase inhibitor (NNRTI).
229
What is an example of a entry inhibitor in HIV?
maraviroc (binds to CCR5, preventing an interaction with gp41), enfuvirtide (binds to gp41, also known as a 'fusion inhibitor')
230
What virus can maraviroc be used for?
HIV1
231
When should you be concerned for Mycobacterium avium complex?
CD4 count is less than 50 cells/mm³
232
Features of mycobacterium avid complex?
fever, sweats
abdominal: pain, diarrhoea
lung: dyspnoea, cough
anaemia
lymphadenopathy
hepatomegaly/deranged LFTs
233
How do you prevent mycobacterium avian complex?
clarithromycin or azithromycin when CD4 is less than 100 cells/mm³
234
Management of mycobacterium avid complex?
rifampicin + ethambutol + clarithromycin
235
Most common neurological complication of HIV?
Toxoplasmosis
236
Features of toxoplasmosis in HIV?
constitutional symptoms, headache, confusion, drowsiness
237
Scan findings for toxoplasmosis in CT?
CT: usually single or multiple ring enhancing lesions, mass effect may be seen
238
Treatment of toxoplasmosis?
management: sulfadiazine and pyrimethamine
239
How to differentiate between toxoplasmosis and lymphoma?
Toxoplasmosis:
Multiple lesions
Ring or nodular enhancement
Thallium SPECT negative
Lymphoma:
Single lesion
Solid (homogenous) enhancement
Thallium SPECT positive
240
HIV: Primary CNS lymphoma is related to what virus?
EBV
241
CSF:
high opening pressure
elevated protein
reduced glucose
normally a lymphocyte predominance but in HIV white cell count many be normal
India ink test positive
Cryptococcus
242
Viruses that causes Progressive multifocal leukoencephalopathy (PML)?
JC virus
243
Features of AIDs dementia complex?
caused by HIV virus itself
symptoms: behavioural changes, motor impairment
CT: cortical and subcortical atrophy
244
When should you worry about oesophageal candidiasis?
<100
245
Treatment for oesophageal candidiasis?
Fluconazole and itraconazole are first-line treatments.
246
What type of organism is PCP?
Pneumocystis carinii pneumonia (PCP)
247
Features of PCP?
dyspnoea
dry cough
fever
very few chest signs
Pneumothorax
248
Exercised induced desaturation
PCP
249
What test should be done to test for PCP?
bronchoalveolar lavage (BAL) often needed to demonstrate PCP (silver stain shows characteristic cysts)
250
Management of PCP
co-trimoxazole
IV pentamidine in severe cases
251
When does seroconversion occur in HIV?
3-12 weeks after infection
252
How do you diagnose HIV?
antibodies to HIV may not be present
HIV PCR and p24 antigen tests can confirm diagnosis
253
Which HIV is known to be worse?
HIV1 is worse than HIV 2
254
What is a Immune reconstitution inflammatory syndrome?
condition generally associated with HIV/immunosuppression
immune system begins to recover,
overwhelming inflammatory response that paradoxically makes the symptoms of infection worse.
255
What virus causes infectious mononucleosis?
Epstein-Barr virus (EBV, also known as human herpesvirus 4, HHV-4)
256
What is the triad of infectious mononucleosis?
sore throat
lymphadenopathy: may be present in the anterior and posterior triangles of the neck, in contrast to tonsillitis which typically only results in the upper anterior cervical chain being enlarged
pyrexia
257
Features of infectious mononucleosis?
palatal petechiae
splenomegaly - occurs in around 50% of patients and may rarely predispose to splenic rupture
hepatitis, transient rise in ALT
lymphocytosis: presence of 50% lymphocytes with at least 10% atypical lymphocytes
haemolytic anaemia secondary to cold agglutins (IgM)
a maculopapular, pruritic rash develops in around 99% of patients who take ampicillin/amoxicillin whilst they have infectious mononucleosis
258
How to diagnose infectious mononucleosis?
heterophil antibody test (Monospot test)
259
Criteria to start antivirals in influenza?
Symptoms within 48 hours
> 65 years old
pregnant women
chronic disease of respiratory, cardiac, renal, hepatic or neurological nature
diabetes
immunosuppression
morbid obesity.
260
Management of influenza?
First line: oseltamivir
Second line: zanamivir
261
How is a Japanese encephalitis virus spread?
culex mosquitos which breeds in rice paddy fields
262
Presentation of JC encephalitis?
headache, fever, seizures and confusion.
Parkinsonian features indicate basal ganglia involvement.
It can also present with acute flaccid paralysis.
263
Differences between legionella and mycoplasma?
Lymphopaenia --> Legionella
Hyponatraemia --> legionella
Haemolytic anaemia --> Mycoplasma
Erythema multiform --> Mycoplasma
encephalitis --> mycoplasma
Myocardiis --> mycoplasma
264
Diagnosis of legionella?
Urinary antigen
265
Diagnosis of mycoplasma?
Serology
266
Treatment for legionella?
treat with erythromycin/clarithromycin
267
What causes leishmiasis?
Leishmania tropica
Leishmania mexicana
268
How is leishmiassi typically diagnosed?
punch biopsy
269
Acquiring leishmaniasis from where means it needs treatment?
cutaneous leishmaniasis acquired in South or Central America merits treatment due to the risk of mucocutaneous leishmaniasis
acquired in Africa or India can be managed more conservatively
270
Causes of mucocutaneous leishmaniasis ?
Leishmania braziliensis
271
Features of mucocutaneous leishmaniasis ?
involve mucosae of nose, pharynx etc
272
What is kala-azar ?
Visceral leishmaniasis
273
Features of visceral leishmaniasis ?
Greyish skin --> Kala Azar
fever, sweats, rigors
massive splenomegaly. hepatomegaly
poor appetite*, weight loss
pancytopaenia secondary to hypersplenism
274
What is the gold standard for diagnosis of visceral leishmaniasis ?
bone marrow or splenic aspirate
275
Causative of leprosy?
Mycobacterium leprae.
276
Features of leprosy?
hypopigmented skin typically affecting the buttocks, face, and extensor surfaces of limbs
sensory loss
277
Lepromatous leprosy?
Low degree of cell mediated immunity
extensive skin involvement
symmetrical nerve involvement
278
Tuberculoid leprosy ('paucibacillary') ?
limited skin disease
asymmetric nerve involvement → hypesthesia
hair loss
279
Treatment of leprosy?
rifampicin, dapsone and clofazimine
280
Features of leptospirosis?
Early phase is due to bacteraemia and lasts around a week:
may be mild or subclinical
fever
flu-like symptoms
subconjunctival suffusion (redness)/haemorrhage
may lead to more severe disease (Weil's disease)
acute kidney injury (seen in 50% of patients)
hepatitis: jaundice, hepatomegaly
aseptic meningitis
281
What is Weil's disease?
acute kidney injury (seen in 50% of patients)
hepatitis: jaundice, hepatomegaly
aseptic meningitis
282
How to diagnose leptospirosis?
serology: antibodies to Leptospira develop after about 7 days
283
Management of leptospirosis ?
high-dose benzylpenicillin or doxycycline
284
What type of bacteria is leptospirosis?
Gram-positive bacillus
285
CSF findings of listeriosis?
cerebrospinal fluid findings:
pleocytosis, often lymphocytes (nontuberculous bacteria usually cause a rise in neutrophils)
raised protein
reduced glucose
286
Management of listeria?
Listeria is sensitive to amoxicillin/ampicillin (cephalosporins usually inadequate)
Meningitis: Listeria meningitis should be treated with IV amoxicillin/ampicillin and gentamicin
287
Who is more likely to get listeria?
Pregnant women
288
Features of listeriosis?
gastroenteritis
diarrhoea
bacteraemia
flu-like illness
central nervous system infection
meningoencephalitis
ataxia
seizures
289
What is loiasis?
a filarial infection caused by Loa Loa.
290
Features of loiasis ?
pruritus
urticaria
Calabar swellings: transient, non-erythematous, hot swelling of soft-tissue around joints
'eye worm' - the dramatic presentation of subconjunctival migration of the adult worm.
291
What causes Lyme disease ?
Borrelia burgdorferi and is spread by ticks.
292
Early features of Lyme disease?
< 30 days
erythema migrans
'bulls-eye' rash is typically at the site of the tick bite
typically develops 1-4 weeks after the initial bite but may present sooner
usually painless, more than 5 cm in diameter and slowlly increases in size
present in around 80% of patients.
293
What is the later features of Lyme disease?
> 30 days
cardiovascular
- heart block
- peri/myocarditis
neurological
- facial nerve palsy
- radicular pain
- meningitis
294
When can Lyme disease be diagnosed clinically?
If erythema migrans is present
295
Diagnosis of Lyme disease ?
(ELISA) antibodies to Borrelia burgdorferi are the first-line test
296
When should ELISA for Lyme disease be repeat?
if negative and Lyme disease is still suspected in people tested within 4 weeks from symptom onset, repeat the ELISA 4-6 weeks after the first ELISA test
297
Management of asymptomatic tick bite?
NICE guidance does not recommend routine antibiotic treatment to patients who've suffered a tick bite
298
Management of Lyme disease?
doxycycline if early disease.
Amoxicillin is an alternative if doxycycline is contraindicated (e.g. pregnancy)
299
Management of disseminated Lyme disease?
ceftriaxone if disseminated disease
300
What is a Jarisch-Herxheimer reaction?
fever, rash, tachycardia after first dose of antibiotic (more commonly seen in syphilis, another spirochaetal disease)
301
Features of severe malaria falciparum ?
schizonts on a blood film
parasitaemia > 2%
hypoglycaemia
acidosis
temperature > 39 °C
severe anaemia
complications as below
302
What is blackwater fever?
Malaria acute renal failure: blackwater fever, secondary to intravascular haemolysis, mechanism unknown
303
First line treatment in non severe malaria falciparum ?
artemisinin-based combination therapies (ACTs) as first-line therapy
artemether plus lumefantrine, artesunate plus amodiaquine, artesunate plus mefloquine, artesunate plus sulfadoxine-pyrimethamine, dihydroartemisinin plus piperaquine
304
Management of severe malaria falciparum ?
intravenous artesunate
305
When should exchange transfusion be completed for malaria?
Parasite count > 10%
306
Common non-malaria falciparums?
Plasmodium vivax
Plasmodium ovale
Plasmodium malariae
307
Presentation of plasmodium oval and vivax?
Plasmodium oval: cyclical fever every 48 hours.
Plasmodium malariae: cyclical fever every 72 hours
308
Presentation plasmodium malariae?
Nephrotic syndrome
309
Treatment of malaria non-falciparum?
artemisinin-based combination therapy (ACT) or chloroquine
310
Management of plasmodium vivax and oval?
Acute treatment: ACT
REQUIREMENT MAINTENANCE TREATMENT
primaquine following acute treatment with chloroquine
311
Complications from measles?
otitis media: the most common complication
pneumonia: the most common cause of death
encephalitis: typically occurs 1-2 weeks following the onset of the illness)
subacute sclerosing panencephalitis: very rare, may present 5-10 years following the illness
febrile convulsions
keratoconjunctivitis, corneal ulceration
diarrhoea
increased incidence of appendicitis
myocarditis
312
Most common cause of meningitis in 0-3?
Group B Streptococcus (most common cause in neonates)
E. coli
Listeria monocytogenes
313
Most common cause of meningitis in 3 months to 6 months?
Neisseria meningitidis
Streptococcus pneumoniae
Haemophilus influenzae
314
Most common cause of meningitis in 6 years to 60 years?
Neisseria meningitidis
Streptococcus pneumoniae
315
Most common cause of meningitis in >60 years?
Streptococcus pneumoniae
Neisseria meningitidis
Listeria monocytogenes
316
Features of bacterial CSF?
Cloudy
Glucose < half of serum
Protein high
Polymorphs 10-1000
317
Features of viral CSF?
Cloudy
60-80% of plasma glucose*
Protein Normal/raised
15 - 1,000 lymphocytes/mm³
318
Features of TB CSF?
Slight cloudy, fibrin web
Low (< 1/2 plasma)
High protein
30 - 300 lymphocytes/mm³
319
Features of fungal CSF?
Low glucose
High protein
20 - 200 lymphocytes/mm³
320
What is the most sensitive test to diagnose TB in CSF?
PCR
Ziehl Neilson is only 20 % sensitive
321
Warning signs in suspected meningitis?
rapidly progressive rash
poor peripheral perfusion
respiratory rate < 8 or > 30 / min or pulse rate < 40 or > 140 / min
pH < 7.3 or WBC< 4 *109/L or lactate > 4 mmol/L
GCS < 12 or a drop of 2 points
poor response to fluid resuscitation
322
When should lumbar puncture not be done?
signs of severe sepsis or a rapidly evolving rash
severe respiratory/cardiac compromise
significant bleeding risk
signs of raised intracranial pressure
focal neurological signs
papilloedema
continuous or uncontrolled seizures
GCS ≤ 12
323
Suspected meningitis: antibiotics 3 months - 50 years?
cefotaxime (or ceftriaxone)
324
Suspected meningitis: antibiotics > 50 years
cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin) for adults
325
Suspected meningitis: Initial empirical therapy aged < 3 months
Intravenous cefotaxime + amoxicillin (or ampicillin)
326
Treatment of haemophilia influenza meningitis?
Intravenous cefotaxime (or ceftriaxone)
327
Suspected meningitis: Listeria meningitis?
Intravenous amoxicillin (or ampicillin) + gentamicin
328
Who should be offered prophylaxis in bacterial meningitis?
exposed to a patient with confirmed bacterial meningitis should be given prophylactic antibiotics if they have close contact within the 7 days before onset
329
Treatment of MRSA?
vancomycin
teicoplanin
linezolid
330
What is muchrmycosis?
Mucormycosis is a fungal infection that is more commonly seen in poorly controlled diabetes.
It typically infects the sinuses, lungs and brain.
331
Complications of mumps?
orchitis - uncommon in pre-pubertal males but occurs in around 25-35% of post-pubertal males. Typically occurs four or five days after the start of parotitis
hearing loss - usually unilateral and transient
meningoencephalitis
pancreatitis
332
Fish tank granuloma?
Mycobacterium marinum
333
Causative organism of type 1 necrotising fascitis?
type 1 is caused by mixed anaerobes and aerobes (often occurs post-surgery in diabetics). This is the most common type
334
Causative organism of type 2 necrotising fascitis?
Streptococcus pyogenes
335
What causes orf?
parapox virus.
found in sheep and goat
336
Presentations of parvovirus B 19
Erythema infectious
asymptomatic
pancytopaenia in immunosuppressed patients
aplastic crises e.g. in sickle-cell disease
chronic haemolytic anaemia
hydrops fetalis
337
Causes of community acquired pneumonia?
Streptococcus pneumoniae (accounts for around 80% of cases)
Haemophilus influenzae
Staphylococcus aureus: commonly after influenza infection
atypical pneumonias (e.g. Due to Mycoplasma pneumoniae)
viruses
338
Who gets Q fever?
abattoir, cattle/sheep or it may be inhaled from infected dust
339
Causes of Q fever?
Coxiella burnetii, a rickettsia
340
Features of Q fever?
typically prodrome: fever, malaise
causes pyrexia of unknown origin
transaminitis
atypical pneumonia
endocarditis (culture-negative)
341
Treated of Q fever?
Doxycycline
342
Negri bodies: cytoplasmic inclusion bodies found in infected neurons
Rabies
343
Features of Rabies?
prodrome: headache, fever, agitation
hydrophobia: water-provoking muscle spasms
hypersalivation
Negri bodies: cytoplasmic inclusion bodies found in infected neurons
344
Rabies wound: Management?
human rabies immunoglobulin (HRIG) should be given along with a full course of vaccination
345
Common cold virus?
Rhinovirus
346
Most common exacerbation of bronchiectasis?
Haemophilus influenza
347
What type of organism is rickettsiae ?
Gram-negative obligate intracellular parasites
348
What test could be done to investigate rickettsiae?
Weil-Felix reaction
349
Cause of endemic typhus?
Rickettsia typhi
Rickettsia prowazekii
350
Scarlet fever incubation?
2-4 days
351
Features of scarlet fever?
fever: typically lasts 24 to 48 hours
malaise, headache, nausea/vomiting
sore throat
'strawberry' tongue
rash
352
Complications of scarlet fever?
otitis media: the most common complication
rheumatic fever: typically occurs 20 days after infection
acute glomerulonephritis: typically occurs 10 days after infection
invasive complications (e.g. bacteraemia, meningitis, necrotizing fasciitis) are rare but may present acutely with life-threatening illness
353
How to assess the severe sepsis?
qSOFA score
Respiratory rate > 22/min
Altered mentation
Systolic blood pressure < 100 mm Hg
354
What is a spinal epidural abscess?
An abscess is a collection of pus encapsulated by a pyogenic membrane.
355
What is the most typical cause of Spinal epidural abscess?
staph aureus
356
Vaccinations in splenectomy?
if elective, should be done 2 weeks prior to operation
Hib, meningitis A & C
annual influenza vaccination
pneumococcal vaccine every 5 years
357
Antibiotic prophylaxis in splenectomy/
penicillin V:
358
What is the antigen behind toxic shock syndrome?
TSST-1 superantigen toxin
359
Features of Toxic shock syndrome?
fever: temperature > 38.9ºC
hypotension: systolic blood pressure < 90 mmHg
diffuse erythematous rash
desquamation of rash, especially of the palms and soles
involvement of three or more organ systems: e.g. gastrointestinal (diarrhoea and vomiting), mucous membrane erythema, renal failure, hepatitis, thrombocytopenia, CNS involvement (e.g. confusion)
360
Coagulase positive staph?
Staph aureus
361
What does staph aureus cause?
Causes skin infections (e.g. cellulitis)
abscesses
osteomyelitis
toxic shock syndrome
362
Multiple painful ulcers on genitals ?
Gential herpes HSV2
363
What type of ulcer do you get in syphilus?
Painless
Chancroid
364
Painful genital ulcers + unilateral, painful inguinal lymph + node enlargement + sharply defined, ragged, undermined border.
Haemophilus ducreyi.
365
Difference between Lymphogranuloma venereum (LGV) and Haemophilus ducreyi?
sharply defined, ragged, undermined border.
366
Stages of Lymphogranuloma venereum (LGV)?
stage 1: small painless pustule which later forms an ulcer
stage 2: painful inguinal lymphadenopathy
stage 3: proctocolitis
367
Stages of Lymphogranuloma venereum (LGV)?
Wstage 1: small painless pustule which later forms an ulcer
stage 2: painful inguinal lymphadenopathy
stage 3: proctocolitis
368
What are the alpha haemolytic streps?
Streptococcus pneumoniae (pneumococcus)
Streptococcus viridans
369
What are the beta haemolytic streps?
Group A
most important organism is Streptococcus pyogenes
Group B
Streptococcus agalactiae
Group D
Enterococcus
370
Treatment of Strongyloides stercoralis?
ivermectin and albendazole
371
Side effects of co-trimoxazole?
hyperkalaemia
headache
rash (including Steven-Johnson Syndrome)
372
Duration from primary to secondary
Primary syphilus up to 6 weeks
Secondary syphilus up to 6- 10 weeks
373
Features of primary and secondary syohilus?
Primary features
chancre - painless ulcer at the site of sexual contact
local non-tender lymphadenopathy
often not seen in women (the lesion may be on the cervix)
Secondary features - occurs 6-10 weeks after primary infection
systemic symptoms: fevers, lymphadenopathy
rash on trunk, palms and soles
buccal 'snail track' ulcers (30%)
condylomata lata (painless, warty lesions on the genitalia )
374
Features of tertiary syphilus?
gummas (granulomatous lesions of the skin and bones)
ascending aortic aneurysms
general paralysis of the insane
tabes dorsalis
Argyll-Robertson pupil
375
What are the types of syphilus tests?
non-treponemal tests
treponemal-specific tests
376
Positive non-treponemal test + positive treponemal test
consistent with active syphilis infection
377
Positive non-treponemal test + negative treponemal test
consistent with a false-positive syphilis result
378
Negative non-treponemal test + positive treponemal test :
consistent with successfully treated syphilis
379
What is the management of syphilus?
intramuscular benzathine penicillin is the first-line management
alternatives: doxycycline
380
Jarisch-Herxheimer reaction treatment?
no treatment is needed
381
Tetanus: full course of tetanus vaccines, with the last dose < 10 years ago
no vaccine nor tetanus immunoglobulin is required, regardless of the wound severit
382
Tetanus:
Patient has had a full course of tetanus vaccines, with the last dose > 10 years ago
High risk wound: reinforcing dose of vaccine + tetanus immunoglobulin
if tetanus prone wound: reinforcing dose of vaccine
383
Tetanus:
reinforcing dose of vaccine, regardless of the wound severity
reinforcing dose of vaccine, regardless of the wound severity
for tetanus prone and high-risk wounds: reinforcing dose of vaccine + tetanus immunoglobulin
384
Treatment for latent TB (assymtopmatic)
3 months of isoniazid (with pyridoxine) and rifampicin, or
6 months of isoniazid (with pyridoxine)
385
Treatment of active tuberculosis (symptomatic)
Initial phase - first 2 months (RIPE)
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol (the 2006 NICE guidelines now recommend giving a 'fourth drug' such as ethambutol routinely - previously this was only added if drug-resistant tuberculosis was suspected)
Continuation phase - next 4 months
Rifampicin
Isoniazid
386
Side effect of rifampicin?
hepatitis, orange secretions
flu-like symptoms
387
Side effect of isoniazid?
peripheral neuropathy: prevent with pyridoxine (Vitamin B6)
hepatitis, agranulocytosis
liver enzyme inhibitor
388
Side effect of pyrazinamide?
hyperuricaemia causing gout
arthralgia, myalgia
hepatitis
389
Side effect of ethambutol?
optic neuritis: check visual acuity before and during treatment
390
Diagnosis of active TB?
3 x sputum smear - stain with ziehl Neilson
Gold standard: Sputum culture
391
Mantoux test: < 6mm
Negative - no significant hypersensitivity to tuberculin protein
Previously unvaccinated individuals may be given the BCG
392
Mantoux test: 6 -15 mm
Positive - hypersensitive to tuberculin protein
Should not be given BCG. May be due to previous TB infection or BCG
393
Mantoux test: >15 mm
Strongly positive - strongly hypersensitive to tuberculin protein
Suggests tuberculosis infection.
394
How can you get a rapid test result for TB?
Nucleic acid amplification tests (NAAT)
allows rapid diagnosis (within 24-48 hours)
more sensitive than smear but less sensitive than culture
395
What is scrub typhus?
caused by Orientia tsutsugamushi
396
Features of scrub typhus?
black eschar at site of original inoculation
relative bradycardia despite fever
397
Management of typhus?
Doxycycline
398
Side effect of vancomycin?
nephrotoxicity
ototoxicity
thrombophlebitis
red man syndrome; occurs on rapid infusion of vancomycin
399
What do you get the Marburg virus from?
bats / caves
400
Councilman bodies (inclusion bodies) may be seen in the hepatocytes
Yellow fever
401
Features of yellow fever?
sudden onset of high fever
rigors
nausea & vomiting
Bradycardia may develop
A brief remission is followed by jaundice, haematemesis, oliguria
402
Treatment of enteric fever
Ciprofloxacin
403
post kala azar dermal leishmaniasis (PKDL)
chronic skin condition that arises after the treatment of visceral disease.
often presents with erythematous or hypo-pigmented macules that may progress to become nodular. Clinically the lesions look very similar to pityriasis versicolour,
404
Treatment for typhus?
Doxycycline is typically used in the management of typhus
405
scrub typhus?
Scrub typhus: black eschar, maculopapular rash, fever, headache
406
Treatment of mycoplasma pneumonia?
macrolide
407
Treatment for genital herpes ?
Oral acyclovir
408
Pregnant + chlamydia?
pregnant then azithromycin, erythromycin or amoxicillin may be used
409
Live attenuated vaccines?
Yellow Fever, BCG, Oral Polio and Varicella
410
Influenza + severe immunocomromise?
ZAMAVIR
411
Staph aureus positive blood culture, length of treatment?
Staphylococcus aureus bacteraemia (SAB) is a serious condition which may occur secondary to soft tissue, joint, bone, indwelling IV line or cardiac infection. It is treated with a minimum of two weeks IV flucloxacillin
412
Retro-orbital headache, fever, facial flushing, rash, thrombocytopenia in returning traveller
Dengue
413
young man presents with a symmetrical rash on his trunk, palms, and soles
syphilus
414
What is the name for bed bugs?
Cimex hemipteru
415
Duration of Lyme disease treatment?
14 days
416
Diagnosis of typhus is through blood culture
/
417
HIV+TB treatment for tb?
rifabutin, isoniazid, ethambutol and pyrazinamide
rifampicin not need as already on taking a protease inhibitor
418
Incubation of plasmodium falciparum?
7-14 days
419
Incubation of plasmodium vivax?
12-17 days
420
Incubation of chikungunya?
2- 12 days
421
Dengue fever incubation?
2- 10 days
422
Immunocompromised + measles exposure?
Provide immunoglobulin urgently
423
When patient is admitted with ? TB what test should be done as will give a quick result?
Quantiferon TB
424
Antibiotics in necrotising fascitis?
Tazocin and clindamycin
425
What is the blood abnormality in Dengue and chikungunya?
Lymphopaenia
Thrombocytopaenia
426
What is the most ocmmon type of necrotising fascitis?
Type 1
Strep pyogenes, clostrium difficult, and e coli
427
What are the two forms of trypanosomiasisomiasis?
African trypanosomiasis
American trypanosomiasis
428
Causative organism of African trypanososomiasis?
Trypanosoma gambiense in West Africa and Trypanosoma rhodesiense in East Africa.
429
How is African trypanososomiasis caught?
tsetse fly.
430
Features of african trypanososomiasis?
Trypanosoma chancre - painless subcutaneous nodule at site of infection
intermittent fever
enlargement of posterior cervical lymph nodes
later: central nervous system involvement e.g. somnolence, headaches, mood changes, meningoencephalitis
431
Treatment of African trypanososmiasis?
early disease: IV pentamidine or suramin
later disease or central nervous system involvement: IV melarsoprol
432
What is the other form of Amercain trypanososmiasis?
American trypanosomiasis, or Chagas' disease
433
What is sleeping sickness?
African trypanosomiasis
434
Features of chugs disease ?
acute phase although a chagoma (an erythematous nodule at site of infection)
myocarditis may lead to dilated cardiomyopathy (with apical atophy) and arrhythmias
gastrointestinal features includes megaoesophagus and megacolon causing dysphagia and constipation
435
Pregnant + influenza?
Zanamivir
436
TB meningitis?
vague headache, lassitude, anorexia and vomiting.
diplopia, papilloedema and hemiparesis and seizures
437
Treatment of TB meningitis?
isoniazid, rifampicin, pyrazinamide and steroids.
438
What should be avoided in TB meningitis?
Ethambutol
439
Rabies wound + Not sought medical attention?
Give immunoglobulin
Give complete vaccination schedule
440
Treatment of choice for systemic salmonella enteric ( typhoid) ?
Cefotxaime
Or
Ciprfo
441
HBeAG positive hepatitis B - treatment?
1. Interferon
2. Tenofovir
If people cannot tolerate tenofovir then use telbivudine
442
Antigens of Hepatitis B ?
HBeAG - first antigen detected, active infection
HbsAG - active infection
anti-HBs - recovery and immunity from hepatitis B virus infection
anti-HBc - acquired infection
IgM anti-HBc - recent infection
443
Epistaxis + bleeding + fevers + equator africa
Yellow fever
444
Epistaxis + bleeding + fevers + south asia?
Dengue
445
Leishmaniasis
446
Can viral haemorrhagic fever cause DIC?
Yes
447
Congo + flu-like symptoms from 3-7 days + painful lymphadenoapthy groin / axilla
Ysersinia pestis
448
What is the pneumococcal vaccine that is used?
23 unconjugated valent pneumococcal vaccine
449
Inclusion bodies in colonic mucosa?
Think viral
CMV
450
Efavirenz toxicity?
cause neuropsychiatric toxicity +psychosis
Myelosuppressive
disturbing dreams and other cognitive disturbances in 50% of patients in the first month of treatment.
451
Acabavir side effect?
Hypersensitivity reaction
specific allele at the human leukocyte antigen B locus, HLA-B*57:01.
452
What malaria causes relapsing disease?
Plasmodium vivax
Plasmodium ovale
453
Malaria more common in india?
Vivax
454
Malaria more common in africa?
Ovale
455
Malaria south east asia?
knowlesi
456
Most common complication of mumps?
Orchitis
457
What is the human herpes virus 5 ?
CMV
458
What does viral tropism do in HIV?
The test for viral tropism determines which of these co-receptors HIV will bind to.
459
In a dural tropic HIV what medication will not work?
Maraviroc
460
Pulmonary involvement + partially acid fast bacilli
Nocardiosis
Occurs in immunosuppressed
461
Treatment of Nocardiosis
Trimethroprim / sulfamethoxole + amikacin + ceftriazone
462
Diagnosis TB: Sputum vs Lavage?
Lavage wins
463
South america + nasal superficial ulceration?
Leishmanisis brazilians
skin lesions may spread to involve mucosae of nose, pharynx etc
464
Calabar swellings: transient, non-erythematous, hot swelling of soft-tissue around joints
Loiasis
465
Treatment of klebsiella pneumoniae ?
polymyxins (e.g. colistin), tigecycline, fosfomycin or aminoglycosides (e.g. gentamicin)
466
Treatment for chagas?
Benzdiazole
467
What does ESBL needd treated with?
resistant to penicillins and cephalosporins and as such the carbapenem class of antibiotics are typically first-line although nitrofurantoin or fosfomycin are also frequently effective.
468
Treatment of TB isoniazid resistant ?
RPE + P for 2 months
R+E for final 4months
469
Test for norovirus?
Faecal / vomit serology
470
Deprived + measles?
Two shots of vitamin A
471
Multi resistant TB drug and disease duration?
multi-drug resistant TB requires 18-24 months of at least 5 drugs.
472
What is Yaws?
chronic infection that affects mainly the skin, bone and cartilage.
Treponema pertenue, a subspecies of Treponema pallidum that causes venereal syphilis. However, yaws is a non-venereal infection.
a single skin lesion develops at the point of entry of the bacterium after 2-4 weeks. This nodule can break down into an exudative ulcer. Without treatment, secondary yaws can occur, resulting in multiple lesions appear all over the body, more commonly over the face, trunk, genitalia and buttocks. Later on in the disease course, widespread bone, joint and soft tissue destruction can occur.
473
Vaccines required in splenectomy ?
if elective, should be done 2 weeks prior to operation
Hib
meningitis A & C
annual influenza vaccination
pneumococcal vaccine every 5 years
474
Difference between schistosome mansoni and S japonicum, S. mekongi and S. intercalatum
AND haemobium
S. mansoni and S japonicum, S. mekongi and S. intercalatum produce eggs that can invade the bowel wall causing an intense inflammatory reaction that gives rise to loose bloody stools. Eggs can also migrate to liver through the portal venous system where they can elicit a granulomatous fibrosing reaction
S. haematobium on the other hand leads to granulomatous inflammation, ulceration of the vesicle and ureteral walls. Subsequent fibrosis can cause bladder neck obstruction, hydroureter and hydronephrosis.
475
Lyme disease ECG?
ECG shows a complete heart block with complete dissociation of the QRS complexes from the p waves
476
Treatment of cryptococcal meningitis in HIV?
IN amphoterasine + flucytosine
477
Treatment for brucellosis ?
Doxycycline + rifampicin for 6 weeks
478
Diagnosis of leptospirosis?
Serum serology
479
Neurocysterocus?
A CT scan subsequently showed cystic and calcified lesions within the brain and mild hydrocephalus
likely his +ve
480
Best test to diagnose trpansomiasis?
lumbar puncture
481
filariform larvae
stronyloides
482
Dietary advice for patients with giardiasis?
avoid dairy
483
TB close contact
If asymptomatic and younger than 65 years then test for latent TB. If Mantoux-negative and unvaccinated then offer vaccination. If at risk of HIV then test for HIV first.
If asymptomatic and older than 65 years then assess with a chest X-ray.
484
Advice pregnancy + zika?
Avoid becoming pregnant 8 weeks after travel
485
HLA B*5701 + HIV
Cannot have abacavir
486
Unwell vet with fever, malaise, arthralgia and lower back pain
Brucellosis
487
Peginterferon alpha 2a is the first line treatment for adults with HBeAg-negative chronic hepatitis B with compensated liver disease. Tenofovir disoproxil or entecavir are second line treatment in those who have detectable HBV DNA after treatment with peginterferon alpha 2a.
Peginterferon alpha 2a is the first line treatment for adults with HBeAg-negative chronic hepatitis B with compensated liver disease. Tenofovir disoproxil or entecavir are second line treatment in those who have detectable HBV DNA after treatment with peginterferon alpha 2a.
488
Traveller diarrhoea + Immunosuppressed + prophylaxis?
Cipfrofloxacin can be used
489
look at his drugs bit
/
490
risk factor for new fasc?
chicken pox
491
African Sleeping Sickness or African Trypanosomiasis. Trypanosoma gambiense is more common than Trypanosoma rhodesiense in patients from West Africa, such as Nigeria.
African Sleeping Sickness or African Trypanosomiasis. Trypanosoma gambiense is more common than Trypanosoma rhodesiense in patients from West Africa, such as Nigeria.
492
PPI can disrupt lower the efficacy of atazanavir
PPI can disrupt lower the efficacy of atazanavir
493
Vancomycin Resistant Enterococcus (VRE) can be treated with linezolid, daptomycin and tigecycline
Vancomycin Resistant Enterococcus (VRE) can be treated with linezolid, daptomycin and tigecycline
494
Risk of vertical transmission for hepatitis C is 6%
Risk of vertical transmission for hepatitis C is 6%
495
slow larva = CLM = Ancyclostoma =skin only
rapid larva = CLC = Strongyloides =skin, bowels, lungs
slow larva = CLM = Ancyclostoma =skin only
rapid larva = CLC = Strongyloides =skin, bowels, lungs
496
Ancyclostoma braziliense.
treatment?
albendazole or ivermectin.
497
test of eradication for strongyloids?
Serology
498
Treatment of Entamoeba histolytica (hydatid cyst)
Metrondiazole
499
Delayed septic joint + gram positive ?
P acnes
