Diseases Flashcards
1
Q
Risk factors for CNS infection (3)
A
Immunodeficiency, chronic otitis media, cranial trauma
2
Q
Contraindications of lumbar puncture (2)
A
cerebral SOL, ↑ ICP
3
Q
Normal opening presure of CSF
A
<15~18 mmHg
4
Q
Normal white cell count in CSF
A
<5 (<30 for 1-month-old infants)
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
6
Q
Kernig sign
A
knee extension is painful –> indicate meningitis
7
Q
Brudzinski sign
A
passive neck flexion elicits hip & knee flexion –> indicate meningitis
8
Q
Bacteria causing acute meningitis in infants <3 months (3)
A
Strep. agalactiae, E. coli (MC), Listeria monocytogenes
9
Q
Bacteria causing acute meningitis in children >3 months (4)
A
Strep. pneumoniae, Neisseria meningitidis, Haemophilus influenzae, TB
10
Q
Bacteria causing acute meningitis in adults (5)
A
Strep. pneumoniae (MC), Neisseria meningitidis, Listeria monocytogenes, TB, Strep. suis
11
Q
MC bacteria causing acute meningitis in infants <3 months
A
E. coli
12
Q
MC bacteria causing acute meningitis in adults
A
Strep. pneumoniae
13
Q
Bacteria causing procedure-related acute meningitis (3)
A
S. aureus, S. epidermidis, GNR
14
Q
Which pathogen commonly causes deafness as complication after acute meningitis?
A
Strep. suis
15
Q
Empirical antibiotics for acute bacterial meningitis
A
IV cefotaxime
16
Q
Which acute bacterial meningitis has the highest mortality?
A
Pneumococcal meningitis
17
Q
If a patient with pneumococcal meningitis shows penicillin and cefotaxime resistant, which antibiotics should be prescribed? (2)
A
vancomycin + rifampicin
18
Q
Which acute bacterial meningitis commonly shows petechiae / purpura?
A
Meningcoccal meningitis
19
Q
Treatment for meningcoccal meningitis
A
Penicillin G (cefotaxime if resistant)
20
Q
Treatment for HiB meningitis
A
ampicillin (amoxicillin-clavulanate, cefotaxime if resistant)
21
Q
Which acute bacterial meningitis is acquired through zoonosis?
A
Strep. suis
22
Q
Acute viral meningitis causative agents (5) (which MC?)
A
Enterovirus (MC), HSV2, VZV, HIV, mumps virus
23
Q
Treatment for cryptococcal meningitis
A
IV amphotericin + flucytosine
[AIDS] lifelong fluconazole maintenance
23
Q
Subacute / chronic meningitis causative agents (2)
A
TB, Cryptococcus neoformans
23
Diagnosis for cryptococcal meningitis
[CSF] India ink, LAT, culture
[Blood] culture & stain
24
Causative agents for acute encephalitis (4)
HSV1,2, Rabies, Japanese encephalitis, Toxoplasma gondii
25
Empirical antimicrobial for acute encephalitis
IV acyclovir
26
MC cause of sporadic encephalitis
HSV1,2
27
Diagnosis for herpes encephalitis
[Onset] CSF HSV PCR
[at day 7 from onset] MRI/ CT/ EEG
[at day 14] intrathecal HSV Ab
28
Prophylaxis for rabies
killed rabies vaccine + HRIG (post-exposure)
29
Vector for Japanese encephalitis
Culex mosquito
30
Which virus causes acute focal encephalitis?
HSV1,2
31
Which virus causes acute pan-encephalitis? (2)
Japanese encephalitis virus, Rabies virus
32
MC CNS infection in AIDS patients
Toxoplasma encephalitis
33
Which parasite causes acute focal encephalitis?
Toxoplasma gondii
34
Pathogen for subacute sclerosing encephalitis
Meales virus (reactivation after years)
35
Pathogen for progressive multifocal leukoencephalopathy
JCV
36
Transmission for poliovirus
faecal-oral route
37
Pathogenesis of poliovirus
direct infection of ventral horn of spinal cord
38
Presentations of poliomyelitis (3)
fever, flaccid paralysis, respiratory dysfunction
39
Vaccines for poliovirus (2)
IM inactivated / oral live
40
Pathogenesis of tetanus
tetanospasmin: retrograde axonal transport from PNS to CNS --> - inhibitory neurons --> spasm
41
Disease with risus sardonicus
tetanus
42
Diagnosis of tetanus
clinical diagnosis only
43
Management for tetanus (4)
Tetanus toxoid vaccine, Tetanus immunoglobulin, ABx on wounds, supportive (e.g. muscle relaxant)
44
Causative agents of Guillain-Barre Syndrome (2+3)
Campylobacter jejuni, Mycoplasma pneumoniae
EBV, VZV, Dengue
45
Presentations of Guillain-Barre Syndrome
ascending paralysis, paraesthesia
46
Management for Guillain-Barre Syndrome
IVIG
47
At which lobe does HSV mostly cause encephalitis?
Temporal lobe
48
Definition of uncomplicated UTI
adult non-pregnant female with no structural / neurological dysfunction
49
Risk factors for UTI (6)
- female
- male before 3m old
- indwelling catheter
- urinatry tract obstruction
- vesiculoureteral reflux
- DM
50
MC bacteria for UTI
E. coli
51
Bacteria causing UTI in young sexually active women
S. saprophyticus
52
Bacteria causing urethritis in male suspected to be STD (3)
Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum
53
Bacteria causing UTI (8)
E. coli, Klebsiella, Proteus, Pseudomonas
S. saprophyticus, S. aureus, Enterococcus, MTB
54
Parasite causing UTI
Schistosoma haematobium
55
3 common urinary specimen and usages
First pass urine: for urethritis
Mid-stream urine (MSU): for cystitis
Terminal urine: for prostatitis
56
Reasons for negative urine culture
- true absence of UTI
- recent ABx use
- diuresis
- fastigious organisms / TB
57
Asymptomatic significant bacteriuria does not require ABx Tx except: (2)
- Pregnancy
- Prior to urogenital procedure
58
Significant bacteriuria definition for MSU
10^5 CFU/mL (colony forming unit)
59
Treatment for urethritis
IM Ceftriaxone once, followed by oral doxycycline / azithromycin
60
Antibiotics for cystitis (3)
PO Nitrofurantoin, Septrin, Augmentin
61
Treatment regimen for cystitis (uncomplicated vs complicated)
Uncomplicated: 3~5d
Complicated: 7d
62
Treatment for pyelonephritis
IV Augmentin / Tazocin until afebrile for 24~48h, followed by 14d PO
63
Antibiotics for prostatitis
PO Ciprofloxacin
64
MC cause for common cold / rhinitis
Rhinovirus
65
MC cause for pharyngitis / tonsilitis
Adenovirus
66
MC cause for epiglotitis
Haemophilus influenzae
67
MC cause for acute bacterial pharyngitis
Streptococcus pyogenes
68
Causes for infectious mononucleosis (or IM-like symptoms) (3)
EBV, CMV, HIV
69
MC causes for AECOPD
Haemophilus influenzae
70
Causes for hospital-acquired pneumonia (3)
Enterobacteriaceae, Pseudomonas aeruginosa, S. aureus
71
Routine workup for pneumonia
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
Clinical triad of infectious mononucleosis + peripheral blood film findings
fever + tonsillar pharyngitis + lymphadenopathy
lymphocytosis, atypical lymphocytes
73
Which patient group is especially vulnerable to infectious mononucleosis and why?
X-linked lymphoproliferative syndrome
EBV in lymphocytes cannot be cleared
74
Diagnosis of EBV infectious mononucleosis
1. Monospot test / Heterophile antibody test
2. EBV IgM
75
Pathogen for upper respiratory tract infection + gray adherent membrane
Corynebacterium diphtheria
76
Management for diphtheria
antitoxin serum + penicillin
77
Empirical antibiotics for CAP (moderate & severe)
Moderate: PO / IV Amoxicillin-clavulanate + Macrolide
Severe: IV Ceftriaxone + Macrolide
78
Empirical antibiotics for HAP
IV Piperacillin-Tazobactem +/- Gentamicin
79
Empirical antibiotics for aspiration pneumonia
IV Ceftriaxone + Metronidazole
80
Managment for lung abscess / empyema
Metronidazole + drainage
81
Antibiotics for Streptococcus pneumoniae
Penicillin G [if susceptible]
Ceftriaxone, Fluoroquinolones
82
Vaccination for Streptococcus pneumoniae
PCV13, PPSV23
83
Pathogen for walking pneumonia
Mycoplasma pneumoniae
84
Pathogen for cold autoimmune hemolytic anaemia
Mycoplasma pneumoniae
85
Diagnosis of Mycoplasma pneumoniae
1. Serology
2. Cold agglutinin test
3. PCR
86
Definition of nosocomial pneumonia
>2d after admission / <2w after discharge
87
Micrological workup for enteric infections
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
What is the most common enteric microflora in small intestine?
Lactobacillus
89
Pathogens for bloody diarrhoea (5)
Shigella, amoeba, EHEC, Campylobacter, C. difficile
90
Pathogens associated with diarrhoea after eating eggs
Salmonella enteritidis
91
Pathogens associated with diarrhoea after eating poultry (2)
Salmonella, Campylobacter
92
Traveller's diarrhoea: MC bacterial & parasitic cause
ETEC
Giardia lamblia
92
Strains for EHEC
O157:H7, O104:H4
93
Pathogen that causes HUS
EHEC
94
Pathogenesis of cholera infection
cholera toxin --> + adenylate cyclase --> ↑ intracellular cAMP --> ↑ Cl secretion --> ↓ Na absorption --> fluid & electrolyte loss
95
Pathogen for "rice water" stool
Vibrio cholerae
96
Screening for pseudomembranous colitis
GDH
97
Treatment for pseudomembranous colits
Oral vancomycin, metronidazole
Faecal microbiota transplant
98
Diagnosis of pseudomembranous colitis
1. Clinical
2. PCR for C. difficile toxins
3. Colonoscopy
99
Workup for HBP infection
USG HBP
Biliary drainage + send specimen for microscopy, gram stain, C/ST
Blood culture, serology for parasites
Stool for parasites
100
Empirical antibiotics for HBP infection
Ampicillin + Cefuroxime + Metronidazole (triple antibiotics)
101
MC pathogen for bacterial liver abscess
Klebsiella
102
Treatment for Amoebic liver abscess
Metronidazole + Paromomycin
103
Complications of liver abscess
pulmonary spread, peritonitis, pericardial rupture
104
Presentations of bacterial liver abscess vs amoebic liver abscess
Onset: rapid; gradual
Fever: high; low
Association: /; hepatomegaly, cough, wheeze, crackles
Abscess: single / multiple; single
105
Vaccine type for HBV
recombinant subunit vaccine
106
Microbiological workup for CNS infection
CSF: gram stain, culture, ST, ZN stain, TB culture, India ink, HSV PCR
Blood culture
107
Empirical treatment for CNS infection
IV Cefotaxime [adults], IV Ampicillin + Gentamicin [neonates]
IV Acyclovir
108
Treatment for Streptococcus agalactiae
Ampicillin
109
Treatment for Listeria monocytogenes
Ampicillin
110
Treatment for E coli neonatal meningitis
Cefotaxime
111
Treatment for TB meningitis
3 HRZE + 9 HR
112
Common pathogens in bone infection (2+2+1)
S. aureus (90%), TB
[neonates] E. coli, Strep. agalactiae
[elderly] Pseudomonas
113
Workup for bone infection
Imaging
Inflammatory markers
Microbiology: culture of bone tissue, needle aspiration, blood
114
Treatment for bone infection (haematogenous, chronic)
Haematogenous: Cloxacillin 4~6w
Chronic: debridement of sequestrum (dead bone) + Cloxacillin >6w
115
Common pathogens in joint infection
S. aureus (MC)
[neonates] E. coli, Strep. agalactiae
[sexually active adults] Nesseria gonorrhoeae
116
Workup for joint infection
Imaging
Inflammatory markers, Rheumatoid factors
Joint aspirate: culture, gram stain
117
Treatment for joint infection
surgical drainage / lavage of joint + Cloxacillin 2~4w
118
Types of surgical wounds
Clean, clean-contaminated, contaminated, dirty
119
Antibiotic prophylaxis for clean-contaminated wounds
Cefazolin
120
Antibiotic prophylaxis for contaminated wounds
Cefuroxime + Metronidazole
121
Workup for soft tissue infections
- Gram stain & culture from:
1. debrided tissues
2. ulcer base / vesicle
3. pus aspirate
- blood culture
122
General management of soft tissue infections (3)
incision & drainage of pus
debridement
antibiotics
123
Soft tissue infections that confine in epidermis only (2) (causative pathogens?)
Impetigo (S. aureus, Strep. pyogenes)
Ecthyma (Pseudomonas aeruginosa)
124
Disease with "honey crust" lesions
Impetigo
125
Treatment for impetigo
Cloxacillin / Vancomycin [MRSA] + Fusidic acid
126
Pathogen & treatment for erysipelas
Strep. pyogenes, Penicillin
127
Pathogen for folliculitis
S. aureus
128
Pathogens for cellulits
Strep. pyogenes, S. aureus
129
Treatment for cellulitis
Amoxicillin-clavulanate / Cloxacillin / Vancomycin [MRSA]
130
Pathogens for necrotizing fasciitis
Strep. pyogenes (MC), Vibrio vulnificus, S. aureus, anaerobes
131
Presentations of necrotizing fasciitis
1. cellulits with haemorrhagic blisters
2. progress to necrosis
3. severe pain out of proportions
132
Subtype of necrotizing fasciitis that invades the scrotum and perineum
Fournier's gangrene 佛尼爾壞死
133
Treatment for necrotizing fasciitis
aggressive surgical debridement + IV Piperacillin-Tazobactem / Meropenem + Metronidazole
134
4 Stages of decubitus ulcer
1. Non-blanchable erythema of intact skin
2. Partial-thickness skin loss
3. Full-thickness skin loss
4. Tissue loss
135
Pathogen associated with leeches bite
Aeromonas
136
Pathogens associated with human bite (4)
Streptococcus, S. aureus, Eikenella corrodens, anaerobes
137
Management of bite wounds (3)
Amoxicillin-clavulanate +/- debridement
Tetanous toxoid vaccine + Ig
Rabies vaccine + HRIG
138
Vesicular rash DDx (3)
VZV, HSV, Hand-foot-mouth disease...
139
Morbilliform rash DDx (8)
Rubella, measles, parvovirus B19, roseola
syphillis, meningococcal petechiae
Kawasaki disease, drug HSR
140
Haemorrhagic rash DDx (2)
Dengue, Chikungunya
141
Hyperplastic rash DDx (2)
Wart, pox (molluscum contagiosum)
142
Centripetal rash DDx (4)
Syphilis, rocky mountain spotted fever,
hand-foot-mouth disease, dengue
(start from extremities)
143
Numbered rashes 1~6
1. Measles
2. Scarlet fever
3. Rubella
4. SSSS
5. Parvovirus B19
6. Roseola
(Mysterious Skin Rash Seek Professional Relief)
144
Risk factors for infective endocarditis (5)
Valvular diseases, IVDA, prosthestic heart valve, poor dental hygiene, immunocompromised
145
MC pathogen for:
(a) Acute IE
(b) Subacute IE
(c) IE with prosthetic heart valve
(d) IE in IVDA
a) S. aureus
b) Strep. viridans
c) S. epidermidis
d) S. aureus
146
Antibiotic prophylaxis for IE (Which groups of patients are indicated?)
PO Amoxicillin
(prosthetic valve, previous IE, congenital heart disease)
147
Antibiotics for IE
Cloxacillin [MSSA] / Vancomycin [MRSA] / Penicillin [Streptococcus] / Ampicillin [Enterococcus] + Gentamicin
+ Rifampicin [prosthetic valve endocarditis]
148
Investigations for IE
>=2 bood cultures
Echocardiogram / TEE
ECG
149
Mechanisms of Janeway lesions in IE
Septicaemia triggers immune response --> formation of immune complex --> septic emboli which deposit bacteria --> form microabscesses
150
What is acute rheumatic fever?
an acute, immunological mediated multisystem inflammatory disease that follows group A Streptococcal pharyngitis after a few weeks
