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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
Q

Pathogen for white cheesey discharge + pruritis vulvae

A

Candida vaginitis

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25
Q

Presentations of STD candidiasis and trichomoniasis respectively in male

A

Candida: balanoposthitis
Trichomoniasis: asymptomatic

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26
Q

Pathogen for malodourous, foamy vaginal discharge

A

Trichomonas vaginalis

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27
Q

Treatment of vagina trichomoniasis

A

tinidazole, metronidazole

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28
Q

Vaginal discharge showing clue cell: which pathogens? (3)

A

Gardnerella vaginalis, Peptostreptococcus, Prevotella

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29
Q

Treatment for bacterial vaginitis

A

metronidazole

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30
Q

Bacteraemia vs Septicaemia

A

Bacteraemia = bacteria in blood
Septicaemia = active multiplying bacteria in blood

31
Q

4 Criteria for SIRS (what’s its full form?)

A

(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
Q

SIRS vs Sepsis

A

Sepsis = evidence of infection + SIRS / SOFA score

33
Q

What is SOFA score? Name some parameters inside (7)

A

Sequential organ failure assessment score
Parameters: MAP, Plt, PaO2, bilirubin, Creatinine, urine output, GCS score

34
Q

Septic shock vs sepsis

A

septic shock = sepsis + hypotension

35
Q

What is superantigen?

A

Ag that binds to TCR & MHC-II directly –> causing non-specific T-cell activation

36
Q

Workup for sepsis

A
  • 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
Q

Pathogens for Waterhouse-Friderichsen syndrome (What is it?)

A

Neisseria meningitidis, Pseudomonas aeruginosa
(severe sepsis –> bilateral adrenal haemorrhage –> adrenal insufficiency)

38
Q

Pathogen and toxin for toxic shock syndrome

A

S. aureus. TSST-1

39
Q

Presentation of toxic shock syndrome 1~3w later

A

desquamation of palms & soles

40
Q

PUO definition

A

temperature >38.3 for >3w without diagnosis after >1w of investigations in hospital

41
Q

Causes of PUO

A

Infection > Neoplasm > Connective tissue disease > no diagnosis

42
Q

Microbiological investigations for tropical travellors (3)

A

serology, thick blood smear, blood culture

43
Q

Pathogen and vector (be specific) for malaria

A

Plasmodium spp.
Anopheles mosquitoes

44
Q

Pathogenesis and protective factor of malaria

A

Pathogenesis: invade RBCs –> dysfunction + plug up post-capillary venules in organs
Protective factor: sickle cell anaemia trait

45
Q

Pathogen for severe malaria

A

Plasmodium falciparum

46
Q

Diagnosis of malaria

A

thick & thin blood smears
rapid diagnostic test (ParaSightF)

47
Q

Thick vs thin blood smear

A

Thick: best for screening
Thin: best for speciation & monitoring

48
Q

Prophylaxis for malaria (4)

A

chloroquine, mefloquine, doxycycline, primaquine

49
Q

Management for malaria (3)

A
  1. Anti-malarial chemotherapy
  2. Monitor blood smears
  3. Avoid sedation & steroids
50
Q

Anti-malarial chemotherapy (3)

A

Complicated falciparum: IV Artesunate
Uncomplicated falciparum: PO coartem
Non-falciparum: Chloroquine

51
Q

Presentations for typhoid fever (4)

A

pulse-temperature deficit, rose spot, splenomegaly, leukopenia

52
Q

Disease with pulse-temperature deficit

A

Typhoid fever

53
Q

Disease with rose spot

A

Typhoid fever

54
Q

Complications of typhoid fever (4)

A

Intestinal haemorrhage, intestinal obstruction, encephalopathy, nephritis

55
Q

Diagnosis and treatment (2) of typhoid fever

A

blood culture
FQ, 3GC

56
Q

Definition of MDR and XDR in typhoid fever

A

MDR: ampicillin, chloramphenicol, septrin
XDR: resistance to FQ, 3GC

(SAC QC)

57
Q

Vaccination for typhoid fever (2)

A

live attenuated
oral (ty21a) or parenteral (Vi polysaccharide)

58
Q

Pathogen for break bone fever, retroorbital pain

A

Dengue virus

59
Q

3 types of presentations of dengue fever

A
  1. Classic Dengue fever
  2. Dengue haemorrhagic fever
  3. Dengue shock syndrome
60
Q

Treatment regimen for Pott disease

A

2HRZE + 10HR

61
Q

Alcoholic hand rub formulation 1 & 2 difference

A

ethanol 96%
isopropyl alcohol 99.8%

62
Q

Contact precautions (3)

A

Use of PPE especially during procedures that produce splashes
Isolation room / cohort nursing
Clean the environment with 1:49 hypochlorite after discharge

63
Q

Definitions of droplet and airborne

A

droplet >5µm in diameter, fall by gravity in 1m

droplet <5µm in diameter, able to travel >3m

64
Q

Droplet precautions

A

Sugical masks, social distancing 1m

65
Q

Airborne precautions

A

Negative pressure isolation room (>6 air changes per hour)

double door system

Fit-tested N95 mask (patient with surgical mask during transport

66
Q

Transmission risk of HBV, HCV and HIV in needle sharp injury

A

30%, 3%, 0.3%

67
Q

Algorithm of HBV status assessment after needle sharp injury

A

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
Q

Presentations of congenital varicella syndrome (6)

A

low birth weight, cutaneous scarring, limb hypoplasia, microcephaly, ocular abnormalities, mental retardation

69
Q

Management of STD

A
  • 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
Q

Workup for vaginal discharge

A
  • 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
Q

Which pathogen causes general paresis of insane?

A

Treponema pallidum (presentation of neurosyphilis)

72
Q

Risk factors for decubitus ulcer

A

immobility, DM, malnutrition, ↓ perfusion, sensory loss

73
Q

What is Mantoux test?

A

a type of tuberculin skin test

74
Q

Full name for PCV13 and PPSV23

A

protein conjugate vaccine
pneumococcal polysaccharide vaccine

75
Q

Household sodium hypochlorite concentration
(what ratio is used for: daily cleaning? vomitus? blood?)

A

50000 ppm
(1:99, 1:49, 1:4)

MED4 MIC (8 decks)

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