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Clinical scenarios Flashcards

1
Q

Incubation period of TB

A

> 2 years

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2
Q

Pathogen for Rasmussen’s aneurysm

A

MTB (complication of pulmonary TB)

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3
Q

Diagnosis of active TB (3, in details)

A
  1. Microscopy (AFB / Ziehl & Neelsen stain)
  2. Culture (Lowenstein-Jensen medium / broth)
  3. PCR (GeneXpert MTB)
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4
Q

Culture time for TB

A

Solid: 6~8w
Liquid:1~3w

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5
Q

Screening for latent TB: indications (2) and methods (2)

A

Indications: clinical suspicion / contact of TB patients
Methods: Tuberculin skin test, IFN-γ release assays

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6
Q

Principle, procedure (how many days), and result of tuberculin skin test

A

Principle: Type IV HSR
Procedure: inject intradermal tuberculin material –> measure area of induration after 2 days
Result: area of induration >10mm => positive

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7
Q

FP (2) & FN of tuberculin skin test

A

FP: BCG vaccine, NTM
FN: immunocompromised, HIV, advanced TB, acute illness…

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8
Q

Principle and FP of interferon-γ release assays

A

Principle: inject antigen –> stimulate T cells to secrete IFN-γ
FP: NTB

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9
Q

Treatment for active TB

A

2 HRZE + 4 HR

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10
Q

Treatment for latent TB

A

Isoniazid 6 months

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11
Q

DDx of STDs (painless ulcer, painful ulcer, bubo)

A

Painless ulcer: syphilis
Painful ulcer: chancroid, genital herpes
Bubo: lymphogranuloma venereum, chancroid

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12
Q

Clinical course of syphilis

A

incubation period: 6 weeks
1. Primary syphilis:
- painless chancre
- resolve in 6 weeks
2. (after 6 weeks) Secondary syphilis:
- maculopapular rash starting from extremities
- condyloma latum [genitalia]
- systemic infection
- resolve in 6 weeks
3. Latent syphilis
- 66% resolve completely
4. (after >6 years) Tertiary syphilis
- Gumma
- Aortitis, Aneurysm
- Neurosyphilis (Tabes dorsalis, Argyll-Robertson pupils…)

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13
Q

Diagnosis of syphilis (active, latent)

A

Active: darkfield microscopy of fresh exudate from lesions
Latent:
- Non-specific test
a. VDRL test (venereal disease research lab)
b. RPR test (rapid plasma reagin)
- (further confirm by) Specific test
a. TPPA test (Treponema pallidum particle agglutination)
b. FTA-abs test (Fluorescent Treponema Antibody-absorption)

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14
Q

Treatment for syphilis

A

IM benzathine penicillin
(if resistant: doxycycline)

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15
Q

Presentations of gonorrhoeae

A

[female] asymptomatic
[male] urethritis

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16
Q

Treatment for gonorrhoeae

A

IM Ceftriaxone once

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17
Q

Diagnosis of gonorrhoeae

A

microscopy & culture of urethral discharge / endocervical swab

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18
Q

MC STD

A

Non-gonococcal urethritis

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19
Q

Treatment of non-gonococcal urethritis

A

PO Doxycycline + Azithromycin

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20
Q

Pathogen for chancroid

A

Haemophilus ducreyi

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21
Q

Pathogen for warts (serotypes?)

A

HPV serotypes 6,11

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22
Q

What cancer is associated with HPV? (which serotypes?)

A

CA cervix (16,18)

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22
Q

Pathogen for molluscum contagiosum

A

Poxvirus

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23
Q

Risk factors for candida vaginitis (3)

A

antibiotics
hormonal imbalance (e.g. OCP)
DM

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24
Pathogen for white cheesey discharge + pruritis vulvae
Candida vaginitis
25
Presentations of STD candidiasis and trichomoniasis respectively in male
Candida: balanoposthitis Trichomoniasis: asymptomatic
26
Pathogen for malodourous, foamy vaginal discharge
Trichomonas vaginalis
27
Treatment of vagina trichomoniasis
tinidazole, metronidazole
28
Vaginal discharge showing clue cell: which pathogens? (3)
Gardnerella vaginalis, Peptostreptococcus, Prevotella
29
Treatment for bacterial vaginitis
metronidazole
30
Bacteraemia vs Septicaemia
Bacteraemia = bacteria in blood Septicaemia = active multiplying bacteria in blood
31
4 Criteria for SIRS (what's its full form?)
(Systemic inflammatory response system) 1. Temperature: >38 or <36 2. Tachycardia: >90 3. Hyperventilation: RR>20 or PaCO2<32 4. WBC abnormality: >12 or <4, or >10% immature forms
32
SIRS vs Sepsis
Sepsis = evidence of infection + SIRS / SOFA score
33
What is SOFA score? Name some parameters inside (7)
Sequential organ failure assessment score Parameters: MAP, Plt, PaO2, bilirubin, Creatinine, urine output, GCS score
34
Septic shock vs sepsis
septic shock = sepsis + hypotension
35
What is superantigen?
Ag that binds to TCR & MHC-II directly --> causing non-specific T-cell activation
36
Workup for sepsis
- Blood culture for >= 2 times from different anatomical sites, 1 hour apart - aerobes, anaerobes, TB, fungi - microscopy, culture, stain, sensitivity test from every possible specimen (e.g. sputum, urine, CSF, tissue from obvious wound...) - serological studies, molecular studies - CBC, LRFT - CXR
37
Pathogens for Waterhouse-Friderichsen syndrome (What is it?)
Neisseria meningitidis, Pseudomonas aeruginosa (severe sepsis --> bilateral adrenal haemorrhage --> adrenal insufficiency)
38
Pathogen and toxin for toxic shock syndrome
S. aureus. TSST-1
39
Presentation of toxic shock syndrome 1~3w later
desquamation of palms & soles
40
PUO definition
temperature >38.3 for >3w without diagnosis after >1w of investigations in hospital
41
Causes of PUO
Infection > Neoplasm > Connective tissue disease > no diagnosis
42
Microbiological investigations for tropical travellors (3)
serology, thick blood smear, blood culture
43
Pathogen and vector (be specific) for malaria
Plasmodium spp. Anopheles mosquitoes
44
Pathogenesis and protective factor of malaria
Pathogenesis: invade RBCs --> dysfunction + plug up post-capillary venules in organs Protective factor: sickle cell anaemia trait
45
Pathogen for severe malaria
Plasmodium falciparum
46
Diagnosis of malaria
thick & thin blood smears rapid diagnostic test (ParaSightF)
47
Thick vs thin blood smear
Thick: best for screening Thin: best for speciation & monitoring
48
Prophylaxis for malaria (4)
chloroquine, mefloquine, doxycycline, primaquine
49
Management for malaria (3)
1. Anti-malarial chemotherapy 2. Monitor blood smears 3. Avoid sedation & steroids
50
Anti-malarial chemotherapy (3)
Complicated falciparum: IV Artesunate Uncomplicated falciparum: PO coartem Non-falciparum: Chloroquine
51
Presentations for typhoid fever (4)
pulse-temperature deficit, rose spot, splenomegaly, leukopenia
52
Disease with pulse-temperature deficit
Typhoid fever
53
Disease with rose spot
Typhoid fever
54
Complications of typhoid fever (4)
Intestinal haemorrhage, intestinal obstruction, encephalopathy, nephritis
55
Diagnosis and treatment (2) of typhoid fever
blood culture FQ, 3GC
56
Definition of MDR and XDR in typhoid fever
MDR: ampicillin, chloramphenicol, septrin XDR: resistance to FQ, 3GC (SAC QC)
57
Vaccination for typhoid fever (2)
live attenuated oral (ty21a) or parenteral (Vi polysaccharide)
58
Pathogen for break bone fever, retroorbital pain
Dengue virus
59
3 types of presentations of dengue fever
1. Classic Dengue fever 2. Dengue haemorrhagic fever 3. Dengue shock syndrome
60
Treatment regimen for Pott disease
2HRZE + 10HR
61
Alcoholic hand rub formulation 1 & 2 difference
ethanol 96% isopropyl alcohol 99.8%
62
Contact precautions (3)
Use of PPE especially during procedures that produce splashes Isolation room / cohort nursing Clean the environment with 1:49 hypochlorite after discharge
63
Definitions of droplet and airborne
droplet >5µm in diameter, fall by gravity in 1m droplet <5µm in diameter, able to travel >3m
64
Droplet precautions
Sugical masks, social distancing 1m
65
Airborne precautions
Negative pressure isolation room (>6 air changes per hour) double door system Fit-tested N95 mask (patient with surgical mask during transport
66
Transmission risk of HBV, HCV and HIV in needle sharp injury
30%, 3%, 0.3%
67
Algorithm of HBV status assessment after needle sharp injury
if HBsAg +ve: refer to hepatologist if HBsAg -ve & anti-HBs IgG: offer 3 dose vaccine --> post-vaccination HBsAg check if unable to produde sufficient IgG: 3-dose trial once more if still unable: hypo- / non-responder --> post-exposure prophylaxis If anti-HBs IgG +ve: no vaccination required
68
Presentations of congenital varicella syndrome (6)
low birth weight, cutaneous scarring, limb hypoplasia, microcephaly, ocular abnormalities, mental retardation
69
Management of STD
- antibiotics - contact tracing + treat sexual partners - screen for other STDs - avoid sexual intercourse until treatment completes - retest all patients ~1 month after treatment to ensure cure
70
Workup for vaginal discharge
- Specimens: vaginal discharge, vaginal swab - Investigations: - Gram stain: look for clue cells - fungal culture: look for oval-shaped yeast with hyphae - microscopy in Feinberg medium: look for pear-shaped trophozoites with jerking movement - PCR
71
Which pathogen causes general paresis of insane?
Treponema pallidum (presentation of neurosyphilis)
72
Risk factors for decubitus ulcer
immobility, DM, malnutrition, ↓ perfusion, sensory loss
73
What is Mantoux test?
a type of tuberculin skin test
74
Full name for PCV13 and PPSV23
protein conjugate vaccine pneumococcal polysaccharide vaccine
75
Household sodium hypochlorite concentration (what ratio is used for: daily cleaning? vomitus? blood?)
50000 ppm (1:99, 1:49, 1:4)

MED4 MIC (8 decks)

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