Corrections 2 Flashcards
What does a history of IVDU coupled with a descending paralysis, diplopia and bulbar palsy indicate?
Clostridium botulinum infection
What can acute toxoplasmosis in immunocompromised patients mimic?
EBV infection (low-grade fever, generalised lymphadenopathy with prominent cervical lymph nodes and malaise)
What is the most reliable method to assess a patient’s response to hep C treatmnet?
Viral load
Mx of campylobacter infections?
Often supportive
However, if severe (e.g. high fever, >8 bowel motions a day) –> treat with clarithromycin
What abx can be used in the mx of severe cases of campylobacter?
Clarithromycin
Triad of features in disseminated gonoccocal infection?
1) tenosynovitis
2) migratory polyarthritis
3) dermatitis
Classical features of dengue fever?
1) retro-orbital headache (behind the eyes)
2) fever
3) facial flushing
4) rash
5) thrombocytopenia
Order of LP vs abx in bacterial meningitis?
Suspected bacterial meningitis: an LP should be done before IV antibiotics, unless:
1) cannot be done within 1 hour
2) LP is contraindicated e.g.
- significant bleeding risk
- signs of raised ICP
- signs of severe sepsis or a rapidly evolving rash
Mx of bed bug infestation?
Fumigation of household via pest management
Why are chemotherapy patients at increased risk of gout?
Chemotherapy causes rapid cell death, leading to the release of purines which are then metabolised to uric acid.
What is Marjolin’s ulcer?
SCC occurring at sites of chronic inflammation or previous injury.
What is pyoderma gangrenosum?
A rare, non-infectious, inflammatory disorder.
It is an uncommon cause of very painful skin ulceration.
It may affect any part of the skin, but the lower legs are the most common site.
What are some associations with pyoderma gangrenosum?
1) Idiopathic (50%)
2) IBD
3) Rheum:
- SLE
- RA
4) Haem:
- lymphoma
5) PBC
Clinical features of pyoderma gangrenosum?
- typically on the lower limb
- small pustule, red bump or blood-blister
- then skin breaks down resulting in an ulcer which is often painful
- the ulcer itself may be deep and necrotic
Look up pics!
Mx of pyoderma gangrenosum?
Steroids
Investigations in fungal nail infection?
nail clippings +/- scrapings of the affected nail –> microscopy & culture
When should microscopy & culture be done in fungal nail infections?
should be done for all patients if antifungal treatment is being considered
N.B. the false-negative rate for cultures are around 30%, so repeat samples may need to be sent if the clinical suspicion is high
Mx of fungal nail infection?
Only treat if symptomatic and patient is bothered by appearance.
If dermatophyte or Candida infection is confirmed:
1st line –> topical treatment with amorolfine 5% nail lacquer (6-12m)
2nd line –> oral terbinafine
3rd line –> oral itraconazole (if Candida infection)
Where does dermatitis herpetiformis typically appear?
Over extensor surfaces
What are the live vaccines?
1) MMR
2) BCG
3) Yellow fever
4) Oral polio
5) Intranasal influenza
6) Varicella
After an initial negative result when testing for HIV in an asymptomatic patient, when should a repeat test be offered?
At 12 weeks post-exposure
Why are platelet transfusions at a particular risk of bacterial contamination?
As they are stored at room temperature
CT results in HSV encephalitis?
Temporal lobe changes
CT findings in a brain abscess?
Ring enhancing lesion with surrounding oedema
(look up pic)
Mx of cerebral toxoplasmosis?
Sulfadiazine + pyrimethamine
1st line abx in a brain abscess?
IV 3rd generation cephalosporin + metronidazole
Investigation of choice in genital herpes?
NAAT
What conditions should ALL pregnant women be offered screening for?
1) HIV
2) Hep B
3) Bacteriuria
4) Anaemia
5) Thalassaemia
6) Syphilis
7) Blood group, Rhesus status and anti-red cell antibodies
8) Risk factors for pre-eclampsia
For patients with gonorrhoea, what can be given if the patient refuses IM ceftriaxone (e.g. needle phobic)?
Cefixime + azithromycin
Features of constrictive pericarditis?
1) dyspnoea
2) peripheral oedema
3) a positive Kussmaul’s sign (the raised JVP that doesn’t fall with inspiration)
Acute vs constrictive pericarditis?
Acute pericarditis is an inflammation of the pericardium that can occur suddenly and resolve on its own, while constrictive pericarditis is a chronic condition that can lead to heart failure.
2 key causes of constrictive pericarditis?
1) any cause of pericarditis (typically repeated episodes)
2) TB
CSF findings in a viral meningitis?
1) raised WCC (lymphocyte predominance)
2) normal glucose
3) normal protein
What is the most common cause of viral meningitis in adults?
Enteroviruses e.g. Coxsackie
What is Bechet’s syndrome?
A a rare multisystem inflammatory disorder characterised by recurrent ORAL AND GENITAL ULCERS, uveitis, and systemic vasculitis.
What is investigation of choice if a LP is contraindicated in meningitis (e.g. due to meningococcal septicaemia)?
Whole blood PCR & blood cultures
If patients are in a pre-hospital setting (for example a GP surgery) and meningococcal disease is suspected, what can be given as long as this doesn’t delay transit to hospital?
IM benzylpenicillin
Give some contraindications to a LP in meningitis
1) signs of severe sepsis or a rapidly evolving rash
2) severe respiratory/cardiac compromise
3) significant bleeding risk
4) signs of raised intracranial pressure
- focal neurological signs
- papilloedema
- continuous or uncontrolled seizures
- GCS ≤ 12
Mx of cellulitis near the eyes or nose?
Co-amoxiclav
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
Location of headache in dengue?
Retro-orbital
Mx of dengue?
entirely symptomatic e.g. fluid resuscitation, blood transfusion etc
no antivirals are currently available
Effect of lymphocytes in Legionella pneumonia?
A key characteristic of this infection is that it typically causes a DECREASE in lymphocytes rather than an increase.
What is the first-line investigation for suspected Lyme disease in patients with no history of erythema migrans?
Enzyme-linked immunosorbent assay (ELISA) antibodies to Borrelia burgdorferi
i.e. blood tests for serology
What reaction is sometimes seen following treatment for syphilis?
the Jarisch-Herxheimer reaction
it is thought to be due to the release of endotoxins following bacterial death and typically occurs within a few hours of treatment
Features of the Jarisch-Herxheimer reaction?
- fever, rash, tachycardia after the first dose of antibiotic
- in contrast to anaphylaxis, there is no wheeze or hypotension
Mx of the Jarisch-Herxheimer reaction?
no treatment is needed other than antipyretics if required
1st line mx of syphilis?
IM benzathine penicillin
How can trimethoprim affect the kidneys?
- rise in creatinine
- hyperkalaemia
What can be given instead of IM ceftriaxone of gonorrhoea in needle phobic patients?
oral cefixime + oral azithromycin
Mx of asymptomatic bacterial vaginosis?
Women with asymptomatic bacterial vaginosis do not usually require treatment unless they are undergoing termination of pregnancy
why is treatment of asymptomatic bacterial vaginosis required in termination of pregnancy?
To reduce the risk of endometritis and PID
What is the most common cause of viral meningitis in the adult population?
What is the most common cause of viral encephalitis in the adult population?
Meningitis –> enteroviruses e.g. Coxsackievirus
Encephalitis –> HSV
Sputum culture in latent vs active TB?
A sputum culture is positive for active TB but negative for latent TB
What is the most appropriate test to check for latent TB?
Mantoux test
Mx of Schistosomiasis?
Praziquantel
Typical CXR findings in Legionella pneumonia?
Bilateral mid-to-lower zone patchy consolidation with small pleural effusions
What disease presentation does the BCG vaccine provide the most protection against?
TB meningitis in children
What class of abx can cause black hairy tongue?
Tetracyclines
What is black hairy tongue?
Black hairy tongue is a temporary, harmless oral condition relatively common condition which results from defective desquamation of the filiform papillae.
Despite the name, the tongue may be brown, green, pink or another colour.
Presentation of diphtheria?
- sore throat with a ‘diphtheric membrane’ - grey, pseudomembrane on the posterior pharyngeal wall
- bulky cervical lymphadenopathy
- neuritis e.g. cranial nerves
- heart block
Mx of diphtheria?
IM penicillin
Mx of immunocompromised patients with toxoplasmosis?
pyrimethamine + sulphadiazine
What type of organism is E. coli?
Gram -ve rod
What test is non-specific for mycobacterium, detecting all species?
Acid fast bacilli (AFB) smear
Length of abx course in Lyme disease?
14-21 day course of oral doxycycline
What c. diff antigen is specifically tested for?
Glutamate dehydrogenase
What monoclonal Ab is sometimes used in the management of C. diff infection?
Bezlotoxumab –> targets C. diff toxin B
Why should Abx be avoided if E. coli gastroenteritis is considered?
Abx & anti-motility agents increase the risk of HUS
What is the gold standard for diagnosing E. coli?
Stool culture & sensitivity
Classical blood test feature of C. diff infection?
Leucocytosis
What is the key carrier of Yersinia enterocolitica?
Pigs (eating raw or undercooked pork can cause infection)
How is giardiasis transmitted?
Cysts released in faeces of mammals.
Symptoms of amoebiasis?
1) dysentry: profuse, bloody diarrhoea
2) liver abscess: usually a single mass in the right lobe (may be multiple):
- RUQ pain
- fever
- systemic symptoms e.g. malaise
- hepatomegaly
3) colonic abscess
Mx of amoebiasis?
metronidazole
Mx of giardiasis?
Metronidazole
How can giardiasis affect stool?
Steatorrhoea
What is the purpose of the Yellow Card scheme in the UK?
Encourages healthcare professionals and patients to report any suspected adverse drug reactions, particularly those associated with new (‘black triangle’) drugs.
What are black triangle drugs?
Medicines that are under intensive monitoring because they are either new to the market, or have very limited post-marketing exposure data.
Campylobacter diarrhoea is typically preceded by what?
A prodromal period e.g. fever, malaise and headache.
What infection can cause rose spots on the abdomen?
Typhoid fever
What organism causes typhoid?
Salmonella typhi
Does typhoid cause diarrhoea or constipation?
Constipation
What is the most commonly used test for the diagnosis of leptospirosis?
Serology - but antibodies may not be present until after 7 days
What is the most common cause of non-falciparum malaria?
Plasmodium vivax
Mx of non-falciparum malaria?
1st line –> artemisinin-based combination therapy (ACT) or chloroquine
Patients with Plasmodium vivax malaria should be given primaquine following acute treatment with chloroquine to destroy liver hypnozoites and prevent relapse.
Typical incubation period for giardiasis?
1-2 weeks
What accounts for 50% of cerebral lesions in HIV patients?
Toxoplasmosis
CT findings in cerebral toxoplasmosis?
usually single or multiple ring enhancing lesions
mass effect may be seen
Mx of cerebral toxoplasmosis?
sulfadiazine and pyrimethamine
What are the 2 focal neuro lesions seen in HIV?
1) toxoplasmosis
2) primary CNS lymphoma
Differentiating toxoplasmosis & lymhoma in HIV patients:
Toxoplasmosis:
- Multiple lesions
- Ring or nodular enhancement
- Thallium SPECT negative
Lymphoma:
- Single lesion
- Solid (homogenous) enhancement
- Thallium SPECT positive
Mechanism of ritonavir (used in HIV mx)?
Protease inhibitor
‘Navir tease a pro’ - HIV drugs that end with -navir are protease inhibitors
Mechanism of zidovudine?
Nucleoside analogue reverse transcriptase inhibitors (NRTI)
LP findings in viral meningitis?
- glucose typically normal
- protein typically raised
What organism typically causes chronic sloughy ulcer with a duration of months without any systemic symptoms?
Pseudomonas aeruginosa
Typical colour of an ulcer caused by Pseudomonas?
Green (also offensive smell)
What can serological tests for syphilis be divided into?
1) non-treponemal tests
2) treponemal-specific tests
Role of non-treponemal tests in the
What type of serological test for syphilis can result in false positives?
non-treponemal tests (as not specific for syphilis)
What are some causes of a false positive non-treponemal test?
- pregnancy
- SLE
- APS
- TB
- leprosy
- malaria
- HIV
Interpret following syphilis test results:
1) Positive non-treponemal test + positive treponemal test
2) Positive non-treponemal test + negative treponemal test
3) Negative non-treponemal test + positive treponemal test :
1) active syphilis infection
2) false positive syphilis result e.g. due to pregnancy/SLE
3) successfully treated syphilis
When is the MenACWY vaccine given?
Typically around the age of 14
Mx of bacterial meningitis in those >50 y/o?
IV cefotaxime + amoxicillin
Features of Lymphogranuloma venereum (LGV) infection?
Typically infection comprises of three stages
stage 1: small painless pustule which later forms an ulcer
stage 2: painful inguinal lymphadenopathy
stage 3: proctocolitis
What investigations are required prior to starting TB therapy?
1) U&Es
2) LFTs
3) Vision testing
4) FBC
Is metronidazole an enzyme inhibitor or inducer?
Inhibitor
What is Lemierre’s syndrome?
An infectious thrombophlebitis of the internal jugular vein following an anaerobic oropharngeal infection.
