SH Revision Session Flashcards
(31 cards)
2nd line tx for syphilis? [1]
doxycycline
Describe how you dx syphilis? [2]
PCR swab: direct test, only on ulcerative lesions, sensitive & specific
Screen for syphilis with an EIA (specific/treponemal) test
RPR is the marker of disease activity - it increases (4 fold increase) in active infection
Describe how you need to think about interpreting treponemal-specific tests (EPA) with regards to future infections etc.
One positive for syphilis will always stay positive
- Therefore need to use RPR and titres (increasing or decreasing) to work out if active infection
A RPR is 1/16.
What change would indicate successful treatment? [1
- 1/16 –> 1/4 would mean effective tx
Which cardiac signs might indicate CV syphilis? [2]
Likes aorta - so might be:
- Aortic regurg: …
- Wide pulse pressure …
What is the incubation period for syphilis? [1]
90 days
If symptomatic: 14 days
If non-symptomatic: 3 months
Which STIs do you do partner treatment for ? [3]
PID infection
- Which cause would be caused by > 5 PMN on microscopy? [1]
NGU
- treat with a week of doxycline
Pawprints :)
If it looks like chlamydia, and acts like chlamydia… think about which organism? [1]
M.gen
How does M.gen present in men and women [3]
How do you treat? [1]
Mostly no disease; gets cleared naturally.
STI associated with urethritis in men and cervicitis and pelvic infection in women
Abx can cause bad side effects so always test on clinical basis
Which specific presentations do you test for, if you suspect M.gen? [2]
PID and non-gonorrhical uthretis
How do you treat M.gen?
If macrolide sensitive: doxycycline 100 mg BD 7/7 followed by azithromycin 1 g asa single dose and then 500 mg daily for 2/7
Macrolide resistant: Moxifloxacin 400 mg OD 7/7 days
Complicated infection (PID or epidimo-orchitis): Moxifloxacin 400mg OD 14/7
Chlamydia needs not test of cure
Gon. 2 weeks
TV: no test of cure
In which cases would you do a test of cure for all STIs? [2]
unless pregnant or needed 2nd line tx
What are the sx of Hep A infection? [3]
Symptoms: (3-10d) hepatitis, flu like symptoms, (1-3 weeks) Jaundice, asymptomatic
Which antibodies can you use to test for Hep A infection? [+]
Tx? [1]
Anti-HAV: total anti-HAV antibodies (HAV IgG)
- Indicates past exposure/immunity
IgM: acute infection
- Tx is supportive
Hep B Antibodies
Acute, chronic or previous Hep B infection? [1]
acute infection is the correct answer,
Positive Anti-HB’s’ = ‘Safe’ (Previous vaccination)
Positive Anti-HB’c’ = Caught (Currently infected)
How do you determine if a patient is acutely suffering from HBV? [1]
How you determine if a patient has immunisation from vaccination? [1]
How you determine if a patient has immunisation from previous infection? [1]
How do you determine if a patient is acutely suffering from HBV? [1]
- HBsAg
How you determine if a patient has immunisation from vaccination? [1]
- A vaccine would only lead to anti-HBs antibodies
How you determine if a patient has immunisation from previous infection? [1]
- immunity due to natural infection also leads to the presence of anti-HBc antibodies & anti-HBs antibodies
Anti-HBs = Safe (Have immunity so either immunised or previously exposed, -ve in chronic disease)
Anti -HBc = Caught (acquired infection at some point rather than immunised)
A 28-year-old female presents with jaundice. The following results are available: HBsAg +ve, HBeAg +ve, HBeAb −ve, HBc IgM +ve
Which of the following interpretations is most accurate?
Susceptible to hepatitis B
Chronic hepatitis B with low infectivity
Chronic hepatitis B with high infectivity
Previous immunisation against hepatitis B
Natural immunity against hepatitis B
A 28-year-old female presents with jaundice. The following results are available: HBsAg +ve, HBeAg +ve, HBeAb −ve, HBc IgM +ve
Which of the following interpretations is most accurate?
Susceptible to hepatitis B
Chronic hepatitis B with low infectivity
Chronic hepatitis B with high infectivity
Previous immunisation against hepatitis B
Natural immunity against hepatitis B
The presence of HBsAg (surface antigen) indicates current infection. The presence of HBeAg (HBV ‘e’ antigen) also indicates current infection, either acute hepatitis B or a chronic carrier state of high infectivity (suggests highly active HBV). IgM antibodies may remain positive in the patient for up to 900 days post-acute phase of hep B infection.
What would the HBV serology for a vaccine responder look like? [1]
Anti-HBsAg +ve only
What would the HBV serology for someone suffering from an acute infection look like? [2]
HBsAg +ve
Anti-HBcAg IgM +ve
