MRCP Infectious disease Flashcards
(192 cards)
1
Q
Measles hallmarks
A
Podrome:
koplik spots (buccal white)
fever
conjunctivitis
cough
Followed by:
Rash behind ear or face spreading down
2
Q
Features of primary syphillis
A
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)
3
Q
Features of secondary syphillis
Secondary syphilis mneumonic: TWO
Trunk rash, warts, oral ulcers
A
systemic symptoms: fevers, lymphadenopathy
symmetrical rash on trunk, palms and soles
buccal ‘snail track’ ulcers (30%)
rash may become condylomata lata (painless, warty lesions on the genitalia )
4
Q
Features of tertiary syphillis
A
gummas (granulomatous lesions of the skin and bones)
ascending aortic aneurysms
general paralysis of the insane
tabes dorsalis
Argyll-Robertson pupil
5
Q
TB sputum MCS
A
Zeihl neelson stain for AFB
6
Q
Why is primaquine and chloroquine given in plasmodium VIVAX and OVALE
A
Primaquine
- clears hypnozites
Chloroquine
- treating symptomatic erythrocytic stage of malaria (anaemia and swining fever)
7
Q
Organism causing IE in IVDU
A
Staph aureus
8
Q
IVDU and new TR
A
endocarditis
TR- PSM + giant CV waves in JVP
9
Q
Antibiotics that cause c.diff
A
CLINDAMYCIN
CIPROFLOXACIN
CARBAPENEM
Cephalosporins
CO-AMOX
10
Q
Chancre
A
painless ulcer on site of sex
11
Q
When should ART be started and prophylaxis for PCP
A
ART as soon as possible
PCP prophylaxis when CD4 <200
12
Q
Strongyloides hallmark
A
nematode
rash on buttock
eosinophilia
abdo pain
diarrhoea
urticaria
Mx: ivermectin or albendazole
13
Q
Actinomyosis hallmarks
A
fungal infection (anaerobic)
endogenous flora
from tooth extraction
lumpy jaw
sulfur granules
prolonged amoxicillin
14
Q
Nocardiasis hallmarks
difficult to differentiate from actinomyoces spp
A
Gram-positive filamentous rod
paraffin bait to culture
- uses as carbon source for growth
painless swelling —> ulceration
Mx: cotrimoxazole
15
Q
oocytes on ZN Stain
A
Cryptosporidium HIV related diarrhoea
16
Q
Dengue fever hallmarks
A
Flavivirus
Mosquito transmission
generalised maculopapular rash
low plt and wcc
fever
viral infection that can progress to viral haemorrhagic fever
BREAK BONE FEVER
17
Q
Warning signs of dengue and management
A
abdominal pain
hepatomegaly
persistent vomiting
clinical fluid accumulation (ascites, pleural effusion)
Mx: supportive
18
Q
What is loeffler syndrome
A
Strongyloide larvae migrate to the lungs a pneumonitis
19
Q
when is co-trimoxazole used
A
PCP in HIV
Cyclospora cayetanensis
(traveller diarrhoea)
20
Q
How long would HIV becomes AIDS if left untreated
A
10 years
21
Q
What is the tirad of HUS and what is the diagnostic method
A
E.coli 0157 SHIGA TOXIN
- AKI
- MAHA (coombs+shistocyte fragment RBC)
- Thrombocytopenia
Stool MCS for e.coli
22
Q
Diagnosis and management of MAC
A
blood cultures
mx:
Mycobacterium
Azithromycin
Clarithromycin
23
Q
dendritic corneal ulcer
A
HSV keratitis
24
Q
Which RBC receptor does malaria vivax bind to?
A
Duffy
note: people with lack of this receptor are resistant to vivax infection
note: people with sickle, thalassaemia and G6PD are resistant to malaria
25
First line treatment for toxoplasmosis
pyrimethamine and sulfadiazine and folic acid
note: pyrimethamine is folate antagonist
26
What is the mechanism of action of vancomycin
prevents formation synthesis of polymers for bacterial cell wall
27
What is the mechanism of action of gentamicin
binds irreversibly to ribosome subunit preventing protein synthesis
28
Mechanism of action of metronidazole
causes oxidative damage to bacterial DNA
29
# M
Mechanism of action of macrolide and clindamycin
inhibitrs ribosomal translocation
30
What is the adverse reaction of vancomycin
red man syndrome
flushing of face neck torso
31
What cancers are HPV 16 and 18 associated with
cervical
anal
32
Which antibiotic should be added on top of ceftriaxone for listeria meningitis?
Amoxicillin/ampicillin
over 60 or immunosuppressed
33
Which virus causes viral meningitis (school teacher)
enterovirus species
34
What is the most effective way in reducing risk of HIV in newborn child
post natal zidovudine to the baby
35
Anopheles mosquito
malaria
36
Aedes mosquito
dengue
yellow fever
zika
37
Orienta tsutsugamushi causes
scrub typhus
causes eschar on bite site
fever, headache, joint pain
lymphadenopathy localised
| tick (Chigger) bite. campers in australia
38
Key travel related infection
Haemorrhagic fever
Rickettsial
Lyme
HIV
Typhoid
Dengue
39
Main sub saharan african infections
plasmodium falciparum
HIV
rickettsia
ebola
40
Main south asian infection
falciparum, vivax and ovale
dengue
typhoid (salmonella)
HIV
41
Tetanus hallmarks
acute neurological
- muscle spasm
- autonomic dysfunction
Due to neurotoxin from c.tetani bacteria
| urgent anti-tetanus immunoglobulin !!!
42
Typhoid fever hallmarks
fever
bradycardia
rose spots (macularpapular rash on chest and abdo)
GI bleed from ulcered peyer's patch in ileum
abdo pain
----> hepatosplenomegaly
| Mx: IV ceftriaxone
43
Diptheria management
ANTITOXIN
+ + macrolide/benpen
44
Side effect of tenofovir
kidney disease
45
COPD/immunocomprosed vaccination
yearly influenza
pneumococcal 5 yearly
46
Brucellosis hallmark
| Bruisedddd Bruce
Zoonosis: Brucella spp
farm animal/unpasteurised milk
FARMERS!!!
Presentation:
ache and pain
fever
weight loss
depression
hepatosplenomegaly
LYMPHADENOPATHY
Mx:
- doxy and rifampicin for 6 weeks
- and aminoglycoside for 2 weeks
47
Management of brucella
doxycycline
rifampicin
gent/cotrimox
triple therapy for 6 weeks
48
Malaria prophylaxis drug
doxycycline
malarone
primaquine
Note: give malarone in epileptic as others reduces seizure threshold
49
Investigation of choice to confirm new HIV
ELISA for HIV antibody and p24 antigen test
note: PCR is for viral load in monitroing
50
Abx of choice for ?meningitis in over 60 years and penicillin allergy
chloramphenicol
with co-trimoxazole
51
What does increasing PR interval suggest in infective endocarditis
uncontrolled infection
need urgent surgery
52
Incubation periods for common organisms
1-6 hrs: Staphylococcus aureus, Bacillus cereus
12-48 hrs: Salmonella, Escherichia coli
48-72 hrs: Shigella, Campylobacter
> 7 days: Giardiasis, Amoebiasis
53
Catch scratch disease
Baronella henselae
cat scratch or bite
lymphadenopathy
self limiting
| tame hensel cat
54
Chlamydia serotypes
Lymphogranuloma venereum (LGV) is caused by Chlamydia trachomatis serovars L1, L2 and L3
- proctocolitis
'Normal' Chlamydia resulting in urethritis and pelvic inflammatory disease is caused by Chlamydia trachomatis serovars D through K.
55
Epidemic typhus
Rickettsia prowazekii
measle like eruption
rural poor hygiene
56
Salmonella typhi organism type
gram -ve rod
57
What is the way to contract strongyloides
soil indwelling
walking barefooted is risk
| vague abdo pain, eosinophilia, malabsorption
58
59
What defines treatment failure of MDRTB?
positive cultures after 4 months of therapy
60
Salmonella vs Shigella food
Salmonella- meat/egg/poultry
Shigella-faeco-oral i.e street fruit etc
61
Botulism
eating contaminated food (e.g. tinned) or intravenous drug use
neurotoxin (exotoxin) often affects bulbar muscles and autonomic nervous system
triad: blurred vision, dysphagia, muscle weakness
62
Neisseria meningitidis grams stain
gram -ve cocci
63
Listeria meningitis gram stain
gram +ve rod
64
strep pneumonia meningitis gram stain
gram -ve cocci
65
EBV hallmarks
glandular fever/mononucleois
fever, pharyngitis, tender LN
66
Parvovirus B19 hallmark
slapped cheek
children
67
Mumps hallmarks
epididymo-orchitis
meningism
68
Rubella hallmarks
maculopapular rash from face to whole body
lymphadenopathy: suboccipital and postauricular
69
Life cycle of malaria
hypnozoites- dormant liver stage of vivax and ovale -> relapse
priaquine and chloroquine given for vivax and ovale to eradiate hypnozoite and prevent relapse
note: falciparum treatment: fansidar (pyrimethamine + sulfadoxine) or tetracycline given after quinine therapy
70
Pre or Post Splenectomy immunisation
| 4-6 weeks or 2 weeks
pneumococcal vaccine
haemophilus ingluenzae B
Meningococcus
risk of encapsulated sepsis
71
Management of cryptospordium in HIV patients and non HIV patients
HIV: start ART
Non HIV: supportive
72
Which live vaccine should be avoided in HIV patients
BCG - risk of TB
73
Chronic diarrhoea, weight loss, arthralgia, hyperpigmentation of skin
Whipple's
74
Side effect of NNRTI
wide spread rash
hepatitis
night night (vivid dreams)
75
Side effect of NRTI
lipoatrophy
B RAMP
Bone marrow supp
Rash
Acidosis
Megaloblastic anaemia (zdv)
Peripheral neuropathy
Pancreatitits
76
Which statin is preferred in hyperlipidaemia in HIV patients
pravastatin (not CYP450 dependent)
77
What is the test for contact tracing for TB exposure
mantoux
| screen for latent TB
78
When is IGRA test used
if mantoux test is +ve
for active TB
79
What are the symptoms of seroconversion of HIV
| point at which the body produces antibodies to HIV
fever
malaise
lymphadenopathy
generalised rash
80
Eikenella corrodens gram stain
gram -ve rod
81
What is the cause of multiorgan complication of diptheria
bacterial exotoxin
82
Dermatophyte that produces microconidia (spores)
Trichophyton spp
athlete's foot
83
Vector for african trypanosomiasis
tsetse fly
84
Hallmark leishmania (visceral and cutaneous)
sandflies
days to months incubation
- erythematous nodule bite site
- golden crust forms
Cutaneous
- skin biopsy
- treat with sodium stilbogluconate
Visceral (kala-azar)
- bone marrow/lymph node/splenic biopsy
- treat with amphotericin B, sodium stilbogluconate
85
Side effect of protease inhibitors
HIL
hyperlipidaemia/hyperglycaemia
gI intolerance
lypodystrophy
especially ritonavir
note: rifampicin decreases PI concentration
86
Side effect of integrase inhibitor
nausea
diarrhoea
headache
Hypercholesterolaemia
87
Encapsulated bacteria
NHS
neisseria
haemophilus
strep
88
penile ulcers
Painful
- Chancroid (thailand sex worker) - gram neg rod
- HSV (multiple ulcer + tender LN + recurrence) - no growth on gram stain
Painless
- syphillis (single ulcer)
- LGV (regional LN)
- granuloma inguinale (donovanosis) - painless spreading friable ulcer
89
Treatment for acute epididymo-orchitis
>35 and not STI (enteric cause)
- olfloxacin first line
<35 and STI cause
- ceftriaxone
90
Legionella hallmarks
hyponatraemia
deranged LFT
diarrhoea
91
Malaria prophylaxis in epileptic
give malarone
92
ALA (amoebic liver abscess) treatment
| due to entamoeba histolytica
metronidazole or tinidazole
93
Hantavirus endemic in...
south korea
scandinavia
| hanta hangook
94
HIV - FBC abnormalities
Normocytic anaemia
Thrombocytopenia
Macrocytosis with ART
95
Prophylaxis for meningococcus contact
cipro first line
alternative: azithromycin
96
Management for gonorrhoea
IM ceftriaxone single dose
alternative:
- PO cefixime and azithromycin
97
Management for chlamydia
doxycycline
alternative:
azithromycin or erythromycin
Note: doxy and olfloxacin CI in pregnancy
98
HIV oesophageal candidiasis management
PO fluconazole 14 days
99
How does early viral meningitis differ from late presentation
early may be polymorphic
late is lymphocytic
100
Listeria meningitits
Lymphocytic
101
Partially treated bacterial meningitis...
present with lymphocytic meningitis
102
What is low CSF glucose
<60% of serum
103
Treatment of TB meningitis
RIPE + streptomycin
like MDRTB
| NOTE: ZN stain may be -ve in CSF due to small amount
104
Parvovirus 19 in adults seen in...
sickle cell anaemia
symmetrical polyarthritis
aplastic crisis
105
Treatment for dengue
supportive
106
How does hep B serology differ between recovered hep B vs hep B carrier
hep B carrier still has surface ANTIGEN
Both has hep B core IgG
107
Management of EBV
supportive
avoid contact sport in first month due to risk of splenic rupture
108
Treatment of toxoplasmosis
if pregnant/newborn/immunocompro
pyrimethamine and sulphadiazine
108
CMV transmission by..
direct bodily fluid
transfusion
transplant
immunocompromised
109
Adult bacterial meningitis caused by...
neisseria
strep pneumonia
110
Meningococcal meningitis caused by..
neisseria meningitides
111
how should deranged LFT in anti TB treatment be managed
stop RIPE
once LFT normalised re-introduce in order of IRP
112
What does strep pyogenes cause
cellulitis
nec fasc
113
Chronic hep B management with decomp CLD
Entecavir
114
Leprosy hallmark
Mycobacterium leprae
granulomatous of peripheral nerve
Sensory loss--> burns
skin biopsy: multiple acide alcohol fast bascilli
Mx: rifampicin, dapsone, clofazimine
115
How is Toxoplasma contracted
cat faeces
116
How is cryptococcus contracted
bird faeces
117
Cryptococcal meningitis management...
amphotericin B with fluconazole
118
Brucella gram stain
-ve coccobacilli
119
Cholera hallmarks
sudden onset
profuse diarrhoea
rice water stool
shell fish/contaminated water
120
Most common cause of treatment failure in HIV
pooor compliance
121
In needle stick injury with patient infected with hep C...
monthly hep C PCR surveillance
if positive then treat with inteferon
122
pneumocytis jirovecii pneumonia hallmarks
IVDU/HIV
lymphopenia
high LDH
desat on exertion
ELEVATED 1,3 BDG (from cell wall)
CXR- bilateral interstitial shadowing
123
Hep C hallmarks
HIV and alcohol associated
Ix:
- hep C antibody
- HCV PCR
- Genotype 1->4
- US if fibrosis seen
- fibroscan/biopsy
treatment:
- protease inhibitors (e.g. daclatasvir + sofosbuvir or sofosbuvir + simeprevir) with or without ribavirin are used
| used to be IFN/peg IFN
124
What is a complication of PCP
pneumothorax
125
126
immunised hep B vs previous infection
vaccination: hep B surface antibody present but no core antibody
127
What should be checked prior to primaquine treatment
screen for G6PD
risk of haemolysis with primaquine
128
Malaria treatment
Severe falviparum/nonfalciparum
- IV artesunate
Non severe disease:
- oral ACT or chloroquine
129
Percentage of untreated syphillis going onto tertiary syphillis
30%
130
Treatment of syphillis
STAT IM benzathine penicillin for primary
131
Management of tropical sprue
tetracycline
(target bacterial overgrowth)
132
Management for ESBL- ECOLI
Meropenem
133
Teicoplanin affective against...
gram +ve
134
Investigation of choice for tertiary neurosyphillis
TPPA (may be positive in yaws too)
VDRL test (non treponeme specific test)
- marker of disease activity
LP and syphillis serology
135
Isolation protocol for MDRTB
negative pressure isolation room
- limit droplet spread
136
EBV and cancer associations
nasopharyngeal carcinoma
Gastric cancer
136
Menongococcal meningitis community SOS treatment
IM benpen
137
When should steroid be given in meningitis
pneumococcal meningitis
138
Shigella mode of transmission
person to person
bloody diarrhoea in nursery
139
How long does TB bacteria take to double in numbers
18-24 hrs
140
Tapeworm management
proglottids in faeces
Mx: niclosamide
141
Ricketssial infection hallmarks
1. Rocky mountain spotted fever
- rickettsia rickettsii
- USA
2. mediterranean spotted fever
- Rickettsi corni
3. scrub typhus
- Orienta tsutsugamushi
4. african tick bite fever
- rickettsia africae from africa
Sx: rash, lymphadenopathy, splenomegaly, eschar ---> regional lymphadenopathy due to draining eschar
Mx: doxycycline
| Mx: doxycycline
142
Needle stick injury with HIV +ve patient
1 month of 3 ART
143
What should be monitored whilst on IV quinine for severe falciparum
BM
(insulin release causing hypoglycaemia)
143
Management of hep A
supportive
self limiting
144
Lyme disease investigation
no need if classical target lesion and evidence of tick bite
If unsure---> ELISA
145
P.vivax prevalent countries
sub saharan
central america
india
146
p.ovale prevalent country
sub saharan africa
147
Severe loiasis management
note: severe case ---> albendazole (as DEC may trigger encephalitis)
148
When is mebendazole indicated
pinworm
whipworm
roundworm
hookworm
149
Thick and thin blood film
Thick: parasite burden
Thin: identify parasite
150
Hallmark of malarial fevers
swining intermittent
151
151
TB isolation rule
Pulmonary TB
Smear positive most infective
**Likely/confirmed MDRTB**
152
Cerebral malaria is associated with...
falciparum
blackwater fefver- haemolysis, dark urine
153
Anti-malaria prophylaxis...
still presents with risk of malaria infection
154
Ancylostoma braziliense hookwork hallmarks
barefoot beach visits or direct soil contact.
moving skin rash
itchy
155
Abx of choice for MRSA cellulitis
Vancomycin
or
teicoplanin
156
CMV encephalitis treatment
Ganciclovir
157
Bacillus cereus
cereal (Rice based dishes)
D+V within 8 hrs of eating
resolve in 1-2 days
158
Mycoplasma pneumoniae
Cold agglutinin
erythema multiforme
dry cough
159
What is the most common side effect of ribavirin for chronic hep c
anaemia
160
Ascariasis hallmarks
Ascaris lumbricoides
eggs hatch in small intestine
larvae enter liver to heart and lungs--> back to digestive tract where they mature into adult worm
Sx: asthma like symptoms
161
Myconic keratitis
Fungal infection of eye
associated with trauma
ulceration in cornea
Antifungals- amphotericin B, itraconazole, natamycin
162
Cause of hairy leukoplakia in HIV
EBV
163
Which malaria prophylaxis can cause acute psychosis
mefloquine
164
Rabies hallmarks
dog and bat bite
Presentation:
encephalitis
hallucination and confusion
hydrophobia (DOES NOT WANT WATER)
Mx:
- if already immunised: for 2 further vaccine
- if not immunised: for immunoglobulin and full vaccination
165
Campylobacter from...
contaminated CHICKEN
| CC
166
Which vaccine is not a live vaccine
Diptheria
167
CMV hallmarks
presents similar to EBV
in severe- pneumonitis, colitis, retinitis
168
Investigation for cryptococcal stain
india ink stain
169
Treatment for adult chicken pox
present within 72 hrs of onset of rash:
- oral aciclovir
- if severe then IV
170
171
Where should you swab for gonorrhoea
mucosal site of symptoms
172
HIV entry to cell
binds to CD4 primary receptor via gp120
with help of co-receptor CCR5
173
Pregnant mum exposed to chicken pox
Urgent IgG
If -ve give VZIG
174
Tropical sprue hallmarks
chronic diarrhoea
malabsorption
travel to tropics
steatorrhoea
175
Animal bite
co-amox
176
Hepatitis vaccines
A and B
177
Severe cellulitis management in penicillin allergy
Clindamycin
178
Cause of hyatid disease (pulmonary and liver cyst)
Echinococcus granulosus
179
Yellow fever hallmarks
viral haemorrhagic fever (also dengue fever, Lassa fever, Ebola).
zoonotic infection: spread by Aedes mosquitos
incubation period = 2 - 14 days
- mild flu-like illness lasting less than one week
- if severe jaundice, haematemesis may occur
180
Staph aureus gram stain
coagulase positive
gram positive coccus in clusters
181
Hep A presentation
bout of intense diarrhoea that resolves
then jaundice, nausea anorexia
182
Immune reconstitution inflammatory syndrome in HIV and TB
Active TB patients who are immunocompromised -> no symptoms
HIV started on ART -> boost immune -> exaggerated response
also associated with cryptococcus and kaposi
Mx: steroids
183
What is klebsiella granulomatis associated with
granuloma inguinale
184
Treatment for Rickettsia
Doxycycline
Pregnant: chloramphenicol
185
Chance of contracting HIV from needle stick
1/300 chance
186
How does clarithromycin affect INR
increases INR as alters warfarin
187
Prosthetic joint replacement septic arthritis causes...
early infection- s.aureus
chronic delayed- s.epidermidis
188
Hand foot and mouth disease
coxackie virus
type 16
self limiting
kindergarden teacher
