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Diseases Flashcards

1
Q

Risk factors for CNS infection (3)

A

Immunodeficiency, chronic otitis media, cranial trauma

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2
Q

Contraindications of lumbar puncture (2)

A

cerebral SOL, ↑ ICP

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3
Q

Normal opening presure of CSF

A

<15~18 mmHg

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4
Q

Normal white cell count in CSF

A

<5 (<30 for 1-month-old infants)

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5
Q

Pathogenesis of meningitis (molecular mechanism)

A
  • meningeal invasion –> replicate in subarachnoid space
  • bacterial cell wall, LPS… –> inflammation & endothelial cell damage
    • ↑ BBB permeability –> hydrocephalus + cell swelling –> cerebral oedema
    • vasculitis –> cerebral ischaemia
    • metabolic distrubances –> vasodilation
      –> ↑ ICP
  • neuronal injury
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6
Q

Kernig sign

A

knee extension is painful –> indicate meningitis

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7
Q

Brudzinski sign

A

passive neck flexion elicits hip & knee flexion –> indicate meningitis

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8
Q

Bacteria causing acute meningitis in infants <3 months (3)

A

Strep. agalactiae, E. coli (MC), Listeria monocytogenes

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9
Q

Bacteria causing acute meningitis in children >3 months (4)

A

Strep. pneumoniae, Neisseria meningitidis, Haemophilus influenzae, TB

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10
Q

Bacteria causing acute meningitis in adults (5)

A

Strep. pneumoniae (MC), Neisseria meningitidis, Listeria monocytogenes, TB, Strep. suis

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11
Q

MC bacteria causing acute meningitis in infants <3 months

A

E. coli

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12
Q

MC bacteria causing acute meningitis in adults

A

Strep. pneumoniae

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13
Q

Bacteria causing procedure-related acute meningitis (3)

A

S. aureus, S. epidermidis, GNR

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14
Q

Which pathogen commonly causes deafness as complication after acute meningitis?

A

Strep. suis

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15
Q

Empirical antibiotics for acute bacterial meningitis

A

IV cefotaxime

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16
Q

Which acute bacterial meningitis has the highest mortality?

A

Pneumococcal meningitis

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17
Q

If a patient with pneumococcal meningitis shows penicillin and cefotaxime resistant, which antibiotics should be prescribed? (2)

A

vancomycin + rifampicin

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18
Q

Which acute bacterial meningitis commonly shows petechiae / purpura?

A

Meningcoccal meningitis

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19
Q

Treatment for meningcoccal meningitis

A

Penicillin G (cefotaxime if resistant)

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20
Q

Treatment for HiB meningitis

A

ampicillin (amoxicillin-clavulanate, cefotaxime if resistant)

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21
Q

Which acute bacterial meningitis is acquired through zoonosis?

A

Strep. suis

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22
Q

Acute viral meningitis causative agents (5) (which MC?)

A

Enterovirus (MC), HSV2, VZV, HIV, mumps virus

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23
Q

Treatment for cryptococcal meningitis

A

IV amphotericin + flucytosine
[AIDS] lifelong fluconazole maintenance

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23
Q

Subacute / chronic meningitis causative agents (2)

A

TB, Cryptococcus neoformans

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23
Q

Diagnosis for cryptococcal meningitis

A

[CSF] India ink, LAT, culture
[Blood] culture & stain

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24
Q

Causative agents for acute encephalitis (4)

A

HSV1,2, Rabies, Japanese encephalitis, Toxoplasma gondii

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25
Q

Empirical antimicrobial for acute encephalitis

A

IV acyclovir

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26
Q

MC cause of sporadic encephalitis

A

HSV1,2

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27
Q

Diagnosis for herpes encephalitis

A

[Onset] CSF HSV PCR
[at day 7 from onset] MRI/ CT/ EEG
[at day 14] intrathecal HSV Ab

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28
Q

Prophylaxis for rabies

A

killed rabies vaccine + HRIG (post-exposure)

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29
Q

Vector for Japanese encephalitis

A

Culex mosquito

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30
Q

Which virus causes acute focal encephalitis?

A

HSV1,2

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31
Q

Which virus causes acute pan-encephalitis? (2)

A

Japanese encephalitis virus, Rabies virus

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32
Q

MC CNS infection in AIDS patients

A

Toxoplasma encephalitis

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33
Q

Which parasite causes acute focal encephalitis?

A

Toxoplasma gondii

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34
Q

Pathogen for subacute sclerosing encephalitis

A

Meales virus (reactivation after years)

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35
Q

Pathogen for progressive multifocal leukoencephalopathy

A

JCV

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36
Q

Transmission for poliovirus

A

faecal-oral route

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37
Q

Pathogenesis of poliovirus

A

direct infection of ventral horn of spinal cord

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38
Q

Presentations of poliomyelitis (3)

A

fever, flaccid paralysis, respiratory dysfunction

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39
Q

Vaccines for poliovirus (2)

A

IM inactivated / oral live

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40
Q

Pathogenesis of tetanus

A

tetanospasmin: retrograde axonal transport from PNS to CNS –> - inhibitory neurons –> spasm

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41
Q

Disease with risus sardonicus

A

tetanus

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42
Q

Diagnosis of tetanus

A

clinical diagnosis only

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43
Q

Management for tetanus (4)

A

Tetanus toxoid vaccine, Tetanus immunoglobulin, ABx on wounds, supportive (e.g. muscle relaxant)

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44
Q

Causative agents of Guillain-Barre Syndrome (2+3)

A

Campylobacter jejuni, Mycoplasma pneumoniae
EBV, VZV, Dengue

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45
Q

Presentations of Guillain-Barre Syndrome

A

ascending paralysis, paraesthesia

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46
Q

Management for Guillain-Barre Syndrome

A

IVIG

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47
Q

At which lobe does HSV mostly cause encephalitis?

A

Temporal lobe

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48
Q

Definition of uncomplicated UTI

A

adult non-pregnant female with no structural / neurological dysfunction

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49
Q

Risk factors for UTI (6)

A
  • female
  • male before 3m old
  • indwelling catheter
  • urinatry tract obstruction
  • vesiculoureteral reflux
  • DM
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50
Q

MC bacteria for UTI

A

E. coli

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51
Q

Bacteria causing UTI in young sexually active women

A

S. saprophyticus

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52
Q

Bacteria causing urethritis in male suspected to be STD (3)

A

Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum

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53
Q

Bacteria causing UTI (8)

A

E. coli, Klebsiella, Proteus, Pseudomonas
S. saprophyticus, S. aureus, Enterococcus, MTB

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54
Q

Parasite causing UTI

A

Schistosoma haematobium

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55
Q

3 common urinary specimen and usages

A

First pass urine: for urethritis
Mid-stream urine (MSU): for cystitis
Terminal urine: for prostatitis

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56
Q

Reasons for negative urine culture

A
  • true absence of UTI
  • recent ABx use
  • diuresis
  • fastigious organisms / TB
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57
Q

Asymptomatic significant bacteriuria does not require ABx Tx except: (2)

A
  • Pregnancy
  • Prior to urogenital procedure
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58
Q

Significant bacteriuria definition for MSU

A

10^5 CFU/mL (colony forming unit)

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59
Q

Treatment for urethritis

A

IM Ceftriaxone once, followed by oral doxycycline / azithromycin

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60
Q

Antibiotics for cystitis (3)

A

PO Nitrofurantoin, Septrin, Augmentin

61
Q

Treatment regimen for cystitis (uncomplicated vs complicated)

A

Uncomplicated: 3~5d
Complicated: 7d

62
Q

Treatment for pyelonephritis

A

IV Augmentin / Tazocin until afebrile for 24~48h, followed by 14d PO

63
Q

Antibiotics for prostatitis

A

PO Ciprofloxacin

64
Q

MC cause for common cold / rhinitis

A

Rhinovirus

65
Q

MC cause for pharyngitis / tonsilitis

A

Adenovirus

66
Q

MC cause for epiglotitis

A

Haemophilus influenzae

67
Q

MC cause for acute bacterial pharyngitis

A

Streptococcus pyogenes

68
Q

Causes for infectious mononucleosis (or IM-like symptoms) (3)

A

EBV, CMV, HIV

69
Q

MC causes for AECOPD

A

Haemophilus influenzae

70
Q

Causes for hospital-acquired pneumonia (3)

A

Enterobacteriaceae, Pseudomonas aeruginosa, S. aureus

71
Q

Routine workup for pneumonia

A

Blood test: CBC (esp. WCC & differential), LRFT, ESR, clotting profile…
Imaging: CXR
Microscopy:
1. Early morning sputum: microscopy, culture, gram stain, sensitivity, ZN stain for AFB, TB culture
2. NPA: PCR for atypicals and viruses
3. Blood: culture for bacteria, serology for atypicals & viruses
4. Urine: Pneumococcal Ag, Legionella Ag

72
Q

Clinical triad of infectious mononucleosis + peripheral blood film findings

A

fever + tonsillar pharyngitis + lymphadenopathy
lymphocytosis, atypical lymphocytes

73
Q

Which patient group is especially vulnerable to infectious mononucleosis and why?

A

X-linked lymphoproliferative syndrome
EBV in lymphocytes cannot be cleared

74
Q

Diagnosis of EBV infectious mononucleosis

A
  1. Monospot test / Heterophile antibody test
  2. EBV IgM
75
Q

Pathogen for upper respiratory tract infection + gray adherent membrane

A

Corynebacterium diphtheria

76
Q

Management for diphtheria

A

antitoxin serum + penicillin

77
Q

Empirical antibiotics for CAP (moderate & severe)

A

Moderate: PO / IV Amoxicillin-clavulanate + Macrolide
Severe: IV Ceftriaxone + Macrolide

78
Q

Empirical antibiotics for HAP

A

IV Piperacillin-Tazobactem +/- Gentamicin

79
Q

Empirical antibiotics for aspiration pneumonia

A

IV Ceftriaxone + Metronidazole

80
Q

Managment for lung abscess / empyema

A

Metronidazole + drainage

81
Q

Antibiotics for Streptococcus pneumoniae

A

Penicillin G [if susceptible]
Ceftriaxone, Fluoroquinolones

82
Q

Vaccination for Streptococcus pneumoniae

A

PCV13, PPSV23

83
Q

Pathogen for walking pneumonia

A

Mycoplasma pneumoniae

84
Q

Pathogen for cold autoimmune hemolytic anaemia

A

Mycoplasma pneumoniae

85
Q

Diagnosis of Mycoplasma pneumoniae

A
  1. Serology
  2. Cold agglutinin test
  3. PCR
86
Q

Definition of nosocomial pneumonia

A

> 2d after admission / <2w after discharge

87
Q

Micrological workup for enteric infections

A

Stool:
- Culture (XLD agar, TCBS agar, Skirrow’s medium +/- alkaline peptone-enhanced TCBS +/- sorbitol MacConkey agar)
- Multipex viral Ag detection (esp. Rotavirus) / PCR
- C. diffile toxin PCR
Blood (systemic involvement only)
Food (pandemic outbreak only)

88
Q

What is the most common enteric microflora in small intestine?

A

Lactobacillus

89
Q

Pathogens for bloody diarrhoea (5)

A

Shigella, amoeba, EHEC, Campylobacter, C. difficile

90
Q

Pathogens associated with diarrhoea after eating eggs

A

Salmonella enteritidis

91
Q

Pathogens associated with diarrhoea after eating poultry (2)

A

Salmonella, Campylobacter

92
Q

Traveller’s diarrhoea: MC bacterial & parasitic cause

A

ETEC
Giardia lamblia

92
Q

Strains for EHEC

A

O157:H7, O104:H4

93
Q

Pathogen that causes HUS

94
Q

Pathogenesis of cholera infection

A

cholera toxin –> + adenylate cyclase –> ↑ intracellular cAMP –> ↑ Cl secretion –> ↓ Na absorption –> fluid & electrolyte loss

95
Q

Pathogen for “rice water” stool

A

Vibrio cholerae

96
Q

Screening for pseudomembranous colitis

97
Q

Treatment for pseudomembranous colits

A

Oral vancomycin, metronidazole
Faecal microbiota transplant

98
Q

Diagnosis of pseudomembranous colitis

A
  1. Clinical
  2. PCR for C. difficile toxins
  3. Colonoscopy
99
Q

Workup for HBP infection

A

USG HBP
Biliary drainage + send specimen for microscopy, gram stain, C/ST
Blood culture, serology for parasites
Stool for parasites

100
Q

Empirical antibiotics for HBP infection

A

Ampicillin + Cefuroxime + Metronidazole (triple antibiotics)

101
Q

MC pathogen for bacterial liver abscess

A

Klebsiella

102
Q

Treatment for Amoebic liver abscess

A

Metronidazole + Paromomycin

103
Q

Complications of liver abscess

A

pulmonary spread, peritonitis, pericardial rupture

104
Q

Presentations of bacterial liver abscess vs amoebic liver abscess

A

Onset: rapid; gradual
Fever: high; low
Association: /; hepatomegaly, cough, wheeze, crackles
Abscess: single / multiple; single

105
Q

Vaccine type for HBV

A

recombinant subunit vaccine

106
Q

Microbiological workup for CNS infection

A

CSF: gram stain, culture, ST, ZN stain, TB culture, India ink, HSV PCR
Blood culture

107
Q

Empirical treatment for CNS infection

A

IV Cefotaxime [adults], IV Ampicillin + Gentamicin [neonates]
IV Acyclovir

108
Q

Treatment for Streptococcus agalactiae

A

Ampicillin

109
Q

Treatment for Listeria monocytogenes

A

Ampicillin

110
Q

Treatment for E coli neonatal meningitis

A

Cefotaxime

111
Q

Treatment for TB meningitis

A

3 HRZE + 9 HR

112
Q

Common pathogens in bone infection (2+2+1)

A

S. aureus (90%), TB
[neonates] E. coli, Strep. agalactiae
[elderly] Pseudomonas

113
Q

Workup for bone infection

A

Imaging
Inflammatory markers
Microbiology: culture of bone tissue, needle aspiration, blood

114
Q

Treatment for bone infection (haematogenous, chronic)

A

Haematogenous: Cloxacillin 4~6w
Chronic: debridement of sequestrum (dead bone) + Cloxacillin >6w

115
Q

Common pathogens in joint infection

A

S. aureus (MC)
[neonates] E. coli, Strep. agalactiae
[sexually active adults] Nesseria gonorrhoeae

116
Q

Workup for joint infection

A

Imaging
Inflammatory markers, Rheumatoid factors
Joint aspirate: culture, gram stain

117
Q

Treatment for joint infection

A

surgical drainage / lavage of joint + Cloxacillin 2~4w

118
Q

Types of surgical wounds

A

Clean, clean-contaminated, contaminated, dirty

119
Q

Antibiotic prophylaxis for clean-contaminated wounds

120
Q

Antibiotic prophylaxis for contaminated wounds

A

Cefuroxime + Metronidazole

121
Q

Workup for soft tissue infections

A
  • Gram stain & culture from:
    1. debrided tissues
    2. ulcer base / vesicle
    3. pus aspirate
  • blood culture
122
Q

General management of soft tissue infections (3)

A

incision & drainage of pus
debridement
antibiotics

123
Q

Soft tissue infections that confine in epidermis only (2) (causative pathogens?)

A

Impetigo (S. aureus, Strep. pyogenes)
Ecthyma (Pseudomonas aeruginosa)

124
Q

Disease with “honey crust” lesions

125
Q

Treatment for impetigo

A

Cloxacillin / Vancomycin [MRSA] + Fusidic acid

126
Q

Pathogen & treatment for erysipelas

A

Strep. pyogenes, Penicillin

127
Q

Pathogen for folliculitis

128
Q

Pathogens for cellulits

A

Strep. pyogenes, S. aureus

129
Q

Treatment for cellulitis

A

Amoxicillin-clavulanate / Cloxacillin / Vancomycin [MRSA]

130
Q

Pathogens for necrotizing fasciitis

A

Strep. pyogenes (MC), Vibrio vulnificus, S. aureus, anaerobes

131
Q

Presentations of necrotizing fasciitis

A
  1. cellulits with haemorrhagic blisters
  2. progress to necrosis
  3. severe pain out of proportions
132
Q

Subtype of necrotizing fasciitis that invades the scrotum and perineum

A

Fournier’s gangrene 佛尼爾壞死

133
Q

Treatment for necrotizing fasciitis

A

aggressive surgical debridement + IV Piperacillin-Tazobactem / Meropenem + Metronidazole

134
Q

4 Stages of decubitus ulcer

A
  1. Non-blanchable erythema of intact skin
  2. Partial-thickness skin loss
  3. Full-thickness skin loss
  4. Tissue loss
135
Q

Pathogen associated with leeches bite

136
Q

Pathogens associated with human bite (4)

A

Streptococcus, S. aureus, Eikenella corrodens, anaerobes

137
Q

Management of bite wounds (3)

A

Amoxicillin-clavulanate +/- debridement
Tetanous toxoid vaccine + Ig
Rabies vaccine + HRIG

138
Q

Vesicular rash DDx (3)

A

VZV, HSV, Hand-foot-mouth disease…

139
Q

Morbilliform rash DDx (8)

A

Rubella, measles, parvovirus B19, roseola
syphillis, meningococcal petechiae
Kawasaki disease, drug HSR

140
Q

Haemorrhagic rash DDx (2)

A

Dengue, Chikungunya

141
Q

Hyperplastic rash DDx (2)

A

Wart, pox (molluscum contagiosum)

142
Q

Centripetal rash DDx (4)

A

Syphilis, rocky mountain spotted fever,
hand-foot-mouth disease, dengue
(start from extremities)

143
Q

Numbered rashes 1~6

A
  1. Measles
  2. Scarlet fever
  3. Rubella
  4. SSSS
  5. Parvovirus B19
  6. Roseola

(Mysterious Skin Rash Seek Professional Relief)

144
Q

Risk factors for infective endocarditis (5)

A

Valvular diseases, IVDA, prosthestic heart valve, poor dental hygiene, immunocompromised

145
Q

MC pathogen for:
(a) Acute IE
(b) Subacute IE
(c) IE with prosthetic heart valve
(d) IE in IVDA

A

a) S. aureus
b) Strep. viridans
c) S. epidermidis
d) S. aureus

146
Q

Antibiotic prophylaxis for IE (Which groups of patients are indicated?)

A

PO Amoxicillin
(prosthetic valve, previous IE, congenital heart disease)

147
Q

Antibiotics for IE

A

Cloxacillin [MSSA] / Vancomycin [MRSA] / Penicillin [Streptococcus] / Ampicillin [Enterococcus] + Gentamicin
+ Rifampicin [prosthetic valve endocarditis]

148
Q

Investigations for IE

A

> =2 bood cultures
Echocardiogram / TEE
ECG

149
Q

Mechanisms of Janeway lesions in IE

A

Septicaemia triggers immune response –> formation of immune complex –> septic emboli which deposit bacteria –> form microabscesses

150
Q

What is acute rheumatic fever?

A

an acute, immunological mediated multisystem inflammatory disease that follows group A Streptococcal pharyngitis after a few weeks

MED4 MIC (8 decks)

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