ID Flashcards
1
Q
Treatment regime in Isoniazod-resistant TB
A
2 months of RIPE
Then further 4 months of Rifampicin and Ethambutol (in place of RI)
2
Q
Features of Strongyloides stercoralis infection (nematode worm)
A
Diarrhoea + abdo pain + bloating
Linear itchy rash (larva currens)
Pneumonitis if larvae migrate to lungs
3
Q
Treatment of Strongyloidiasis
A
Ivermectin/albendazole
4
Q
Features of Strongyloides Hyperinfection Syndrome (proliferation of larvae in immunosuppression)
A
Paralytic ileus
Sepsis due to gut bacteria translocation
Pulmonary infitrates
5
Q
Suspect Lyme disease - erythema migrans is present
A
Treat: Doxycyline 14 - 21 days
6
Q
Suspect Lyme disease - no erythema migrans.
A
ELISA for Borrelia burgdorferi antibodies
7
Q
Suspect Lyme disease - (no erythema migrans) - Borrelia ELISA serology negative at <4wk since symptom onset
A
Repeat ELISA in 4-6wk
8
Q
Suspect Lyme disease - (no erythema migrans) - Borrelia serology negative at >12wk since symptom onset
A
Immunoblot
9
Q
Suspect Lyme disease - (no erythema migrans) - Borrelia ELISA positive
A
Immunoblot test
10
Q
Suspect Lyme disease - (no erythema migrans) - Borrelia serology equivocal
A
Immunoblot
11
Q
Management of early Lyme disease - in pregnancy
A
Amoxicillin (doxycycline CI in pregnancy)
12
Q
Management of disseminated Lyme disease - in pregnancy
A
Ceftriaxone
13
Q
Monitoring of HIV
A
Viral load every 6m
CD4 count annually
14
Q
Clostridium botulinum - bacterial identification
A
Gram positive anaerobic bacillus
15
Q
Management of botulism
A
Botulism antitoxin (if early) Supportive care
16
Q
Features of leprosy
A
Hypopigmented patches
Anaesthetic nodules
May be symmetrical or asymmetrical nerve involvement
Alopecia
17
Q
Diagnosis of leprosy
A
Skin biopsy
18
Q
Management of leprosy
A
Triple therapy:
Rifampicin + dapsone + clofazimine
Prednisolone or other steroids for nerve pain and muscle pain
Thalidomide- to surpress immune system (contrindicated in pregnancy)
19
Q
Features of Mycoplasma pneumonia
A
Dry cough
Prolonged flu-like
Erythema multiforme
Hyponatraemia
Haemolytic anaemia (cold agglutinins)
20
Q
Treatment of latent TB (asymptomatic TB, positive blood test, no imaging findings)
A
Dual therapy, either:
3 months of Isoniazid (+Pyridoxine) + Rifampicin
or
6 months of Isoniazid (+Pyridoxine)
21
Q
Which drugs risk re-activation of TB
A
TNF inhibitors:
Etanercept
Infliximab
22
Q
Tests used to diagnose latent TB
A
Quantiferon (IFN-g release assay)
Mantoux
23
Q
Features of Dengue fever
A
Fever
Severe bone/muscle aches
Retro-orbital headache
Maculopapular rash
Low WCC, low PLT
Haemorrhagic phase
24
Q
Treatment of Dengue fever
A
Supportive
25
Features of Scrub typhus
Fever + muscle pain
Eschar at mite entry site
26
Features of Typhoid fever
Symptoms occurs 10-20 days following exposure, causes:
High fever
Dry cough
abdomina pain + green diarrhea
Relative bradycardia
Rose spots
Reactive athritis
27
Features of Chikungunya fever
Severe joint pain + swelling
High fevers
Lymphopenia
Thrombocytopenia
28
Ross River Virus - endemic in
Australia
29
Chikungunya fever - endemic in
Africa
Asia
Caribbean
30
Treatment for schistosomiasis
Praziquantel
31
Treatment for giardiasis
1 week Metronidazole
or
3g Tinidazole stat
32
Cryptococcus meningitis (fungal) - CSF findings
Raised opening pressure
Lymphocytosis
High protein
Low glucose
33
Management of Cryptococcus meningitis
Amphotericin B
34
Treatment for amoebic liver abscess
Metronidazole
35
Treatment of fungal liver abscesses
Amphotericin B
36
Treatment for intestinal amoeba (after treated the liver abscess)
Diloxanide furoate
37
Antibiotic for Legionnaire's disease
Macrolide (clarithromycin/erythromycin) or quinolone (levofloxacin)
38
Antibiotic treatment of Listeria meningitis
IV amoxicillin/ampicillin + gentamicin
39
Antibiotic treatment of tetanus wound (after debridement and tetanus globulin)
Metronidazole IV
40
1st line management of Brucellosis
Oral doxycycline + rifampicin
41
Management of Brucellosis with neurological involvement
IV Ceftriaxone + doxycycline + rifampicin
42
Management of brucellosis with endocarditis
Gentamicin + doxycycline + rifampicin
43
Presentation of Yersinia enterocolitica
Pseudo-appendicitis
Reactive arthritis
Erythema nodosum
44
Treatment of Yersinia
Aminoglycoside (gentamicin)
45
Treatment of salmonella typhi
ceftriaxone
46
DIffuse macular/papular/nodular rash with discoloration, after treatment for visceral leishmaniasis
Post-kala-azar dermal leishmaniasis (PKDL)
47
Visceral leishmaniasis "kala-azar" (spread by sand fly) - endemic in
Mediterannean, Middle East, Asia, Africa, S. America,
48
Features of Giardiasis
Prolonged diarrhoea \>10days
Bloating, abdo pain
Non-bloody
49
Farmer, with fever, pneumonia, transaminitis, think...
Q fever (Coxiella burnetii)
50
Treatment of Q fever (Coxiella)
Doxycycline
51
Management of mild PCP
Co-trimoxazole
52
Management of moderate/severe PCP
(eg diffuse shadowing on CXR/ low sats/ breathless at rest),
Co-trimoxazole + corticosteroids
53
What does a positive IGRA (interferon-gamma release assay) indicate?
Active or latent TB
54
What might positive Mantoux test (induration 6-15mm) indicate?
Latent TB
Miliary TB
Sarcoidosis
HIV
Lymphoma
55
Antibiotic used for Shigella (if needed)
CIprofloxacin
56
Antibiotic used for Campylobacter (if needed)
Ciprofloxacin
57
Antibiotic used for Cholera (if needed)
A tetracycline
58
Features of Brucellosis
Fever, malaise
Sacroiliitis
Contact with sheep/goats
or animal products in Med/Middle East
59
Features of malaria
Fever, myalgia
Jaundice
Hepatosplenomegaly
60
Features of viral haemorrhagic fevers (Yellow fever, Dengue, Ebola, Lassa)
Prodrome
Anaemia, thrombocytopenia
Renal failure
DIC
61
Treatment of uncomplicated Falciparum malaria
"ACT" Artemisinin-based combination therapy (eg artesunate plus mefloquine)
62
Treatment of severe/complicated Falciparum malaria
IV artesunate
Exchange transfusion if parasite count \>10%
63
Who needs to be treated for non-typhoidal salmonella gastroenteritis?
\>50 years old and:
Immunocompromised
Valve disease
Endovascular abnormality
64
Features of Yellow fever
Fever + malaise
Jaundice
Conjunctival injection
Relative bradycardia
65
Councilman bodies in hepatocytes - seen in which disease
Yellow fever
66
Antibiotics used to treat carbapenemase producing enterobacteriaceae (CPE)
Gentamicin (macrolide)
Tigecycline
Fosfomycin
Colistin
67
Treatment of typhoid fever
Cefotaxime/ceftriaxone
68
Features of Visceral Leishmaniasis (kala-azar)
Fevers
Hepatosplenomegaly
Pancytopenia
Grey skin
69
Gold standard test for visceral leishmaniasis
Bone marrow or splenic aspirate (amastigote parasites)
70
Confusion in returned traveller from Asia, think
Japanese encephalitis
71
HIV positive with headache and neurological symptoms, think...
CNS cryptococcus
72
Test for Cryptococcus
India ink
73
Treatment of CNS cryptococcal infection
IV amphotericin B + flucytosine
74
Treatment of staph aureus bactaraemia
At least 2 weeks of IV Flucloxacillin
75
Features of acute schistosomiasis infection
Cough
Bloody diarrhoea
Eosinophilia
Splenomegaly
76
Diagnosis of intestinal Cryptosporidium parvum (protozoan)
Cysts seen on acid-fast stain of stool culture
77
Indication for varicella-zoster immunoglobulin (VZIG)
Should be given within 7 days of exposure to:
Immunosuppressed
Neonates
Pregnant without varicella antibodies
78
Management of chickenpox in immunocompromised individuals (once developed chickenpox)
IV aciclovir
79
Fever on alternate days - suggestive of
P. vivax or P. ovale malaria
80
Treatment of plasmodium vivax malaria
Chloroquine + primaquine (for hyponozoites)
81
Gold standard diagnostic test for strongyloidiasis
Stool microscopy
82
Best test for strongyloidiasis eradication
Serological testing
83
Management of low-severity community acquired pneumonia
Amoxicillin 5 days
84
Management of low-severity community acquired pneumonia (pen-allergic)
Macrolide (clarithromycin) or tetracycline 5 days
85
Management of moderate severity community acquired pneumonia
Amoxicillin + macrolide 7-10 days
86
Management of high severity community acquired pneumonia
Co-amoxiclav (or ceftriaxone/tazocin) + macrolide
87
CURB-65 score - 1 point for C if
AMTS \<= 8/10
88
CURB-65 score - 1 point for U if
Urea \> 7
89
CURB-65 score - 1 point for R if
RR \>= 30
90
CURB-65 score - 1 point for B if
Systolic \<= 90 or diastolic \<= 60
91
Management of CURB-65 score 2+
Consider hospital admission
92
Management of CURB-65 score 3+
Consider ITU
93
Which HIV patients should receive PCP (pneumocystis carinii) prophylaxis
All those with CD4 count \<200/mm
94
Which non-HIV patients should receive PCP prophylaxis
Transplant recipients (solid organ or stem cell)
Taking steroids + another immunosuppressant for \>1m
AI condition with lung involvement + high dose steroid \>1m
95
Diagnosis of PCP
Broncho-alveolar lavage - shows cysts with silver staining
96
Initial empirical treatment for meningitis if \<3 months old
IV cefotaxime + amoxillin/ampicillin)
97
Initial empirical treatment for meningitis if 3 months - 50 years old
IV cefotaxime/ceftriaxone
98
Initial empirical treatment for meningitis if \>50 years old
IV cefotaxime/ceftriaxone + amoxicillin/ampicillin
99
Treatment of meningococcal meningitis
IV benzylpenicillin
or
IV cefotaxime/ceftriaxone
100
Treatment of pneumococcal meningitis
IV cefotaxime/ceftriaxone
101
Treatment of meningitis caused by Haemophilus influenzae
IV cefotaxime/ceftriaxone
102
Treatment of meningococcal meningitis (pen-allergic)
Chloramphenicol
103
Treatment of meningitis caused by Haemophilus influenzae (pen-allergic)
Chloramphenicol
104
Haemophilus influenzae appearance under microscope
Gram-negative coccobacilli
105
Chlamydia trachomatis gram-stain
Gram-negative coccobacilli
106
Management of close contacts of meningococcal meningitis (close contact within the 7 days before onset)
PO ciprofloxacin STAT
or PO Rifampicin BD 2 days
or IM ceftriaxone
Meningococcal vaccination when serotype availabe
107
Which tick carries Babesia?
Ixodes Tick
108
What are the haematological symptoms/complications of Babesia?
Haemoglobinuria
Jaundice (haemolytic anaemia)
Hyergammaglonimaemia
NB: Higher risk of symptoms in sickle cell disease/asplenia patients
109
Symtoms of Babesiosis?
Irregularly cycling FEVERs
110
Diangosis for Babesia?
Blood smear (maltese cross)- cross is from a tetrad of trophozoites
111
Treatment for Babseia?
Oral Atovaquone and Oral Azithromycin
Immunocompromised= IV azithromycin and oral atovaquone
ALternative: IV clindamycin and oral quinine
112
Indication for exchange transfusion in patients with severe babseia?
```
High grade parasitemia (\>10%)
severe haemolysis (Hb \<10)
organ dysfunction (pulmonary, renal, liver)
```
113
Patient bitten by stray dog and has never been given prophylaxis for rabies. Rx?
Vaccination:
- Day of presentation
- Days 3,7,14,30
- IVIG
114
What is Katayama fever?
Manifestation of acute shcistosomiasis; features include urticarial rash, hepatpsplenomegaly and bronchospasm
115
1st and 2nd line Rx of genital warts
1) Podophyllotoxin ointment
2) cryotherapy
116
Burcellosis-transmission?
Ingestion of contaminated food products, especially unpasteurised milk
117
Burcellosis; symptoms?
Weight loss, bone pain, splenomegaly and parodoxical bradycardia, neutropenia, thrombocytopenia
118
Brucellosis gold standard investigation?
Bone marrow aspirate and culture (facultative intracellular organism)
119
Brucellosis Treatment?
Doxycycline + Streptomycin/Rifampicin for 6 weeks
120
Commonly isolated orgnaism from human bites?
Streptococcus, Staphylococcus, Haemophilus, Bacteriodes and Eikenlla?
121
Presentation of Echinococcus?
Hydatid Cyst, flu like symptoms, Nausea/Vomtiing, boating, abdominal pain, billiary dysfunction (jaundice)
122
Rx of Echinococcus?
Albendazole
123
Symptoms of Salmonella Typhi other than rose spots?
Fever, Myalgia, headache Dry Cough, Heapto-Splenomegaly
124
Incubation period of salmonella typhi?
3 weeks
125
Symptoms of Mycobacterium Avium?
Respiratory symptoms, weight loss, diarrhoea, generalised lymphadenopathy and abnormal LFTs
126
Who is at risk of norcardia?
Immunocompromised (steroids, HIV, transplant patients)
127
Symptoms of Norcardia?
Respiratory: Pneumonia/cavitaing lesions
Neurological: brain abscess
Skin: indurated skin lesions
128
Rx for Norcardia?
Sulphadiazine
129
Rx for Diptheria?
Diptheria antitoxin + Abx (erythromycin)
130
Major complication of Diptheria?
Myocarditis
131
When is a Nucleic Acid Amplification test (NAAT) used?
When suspective/looking for Gonococcus or Chlamydia
132
What is Yaws?
Caused by Treponema Pertenue. Similar to Syphyllis. Transmitted skin to skin contact. PResentation is one or multiple skin lesions which may ulcerate.
133
What is a risk factor for anthrax?
Infected carcasses
134
What is the presentation of anthrax?
Initial pustule at site of infection which progress to form BLACK ESCHAR
135
Presentation of loa loa?
Erythematous papules across the legs. Several months ater infetion it causes temporary swelling due to block of lymphatic drainage.
NB: Loa Loa cauases filiariasis which presents with intermittent fevers, pulmonary infiltrates and eosinophilia + the symptoms mentioned above
136
Signs and symptoms of entomebea histolytica?
constitutional symptom of myalgia and fever
hepatomegaly and pleural effusion (cough)
137
What is the clinical presentation of yersinia?
Symptoms may be precedied by appearance of erythema nodosum
Causes mesenteric adenitis: fever, abdo pain and RLQ tenderness, nausea, vomiting and apthous ulcers.
Can also cause: asymmetrical polyarthritis, enteritis, uveitis, appendicits and glomerulonephritis
138
What is the treatment for Filiariasis?
1st line- Diethylcarbamazine (DEC)
But if high parasitic load- 2nd line is Ivermectin
139
140
Diagnosis and Treatment for Typhoid Fever?
Blood cultures for diagnosis
Azithromycin for treatement (Ceftriaxone if severe)
141
Describe the typical onset of features for Weil's Disease
Incubation: 1-3 weeks
Acute face: abrupt onset of fever, headache, myalgia, dry cough and lethargy
This face may resolve without Rx but can lead to Immune Phase:
- Jaundic
- Abdominal Pain
- Diarrhoea
- Rash
- Meningitis
- Organ Failure (renal impairment)
142
Rx for Infective Endocarditis caused by Bacillus Cereus
Vancomycin
143
144
145
Molluscum contagiosum in adults should raise suspicion of what?
HIV
146
Management of optic neuropathy secondary to Ethambutol?
Stop the medication and urgent ophtalmology opinion
147
What are the 2 classification of leprosy?
Lepromatuous Leprosy
Tuberculoid leprosy
148
What determines the type of leprosy
DEGREE OF CELL MEDIATED IMMUNITY
LOW DEGREE = LEPROMATOUS
HIGH DEGREE = TUBERCULOID
149
Features of lepromatous leprosy (multibacilary)
extensive skin involvement (hence the term MULTIbacillary)
symmetrical nerve invovlement
involvement of kidneys, genitals, nose and mouth
MOST CONTAGIUS
150
Features of tuberculoid leprosy?
limited skin disease
asymmetric nerve invovlement
hair loss
151
Features of Trypanosoma Brucei Rhodesiense?
Erythematous swelling or chancre at site of fly bite 5-15 days later
fever, headache, myalgia
THEN PROGRESSES to meningoencephalitis
daytime somloence
152
Investigations for Tryposonoma Bruceir Rhodesiense?
CT of head prior to LP
153
What will CT/MRI head show in infection with tryposonoma brucei rhodesiense
Late disease shows cerebral oedema and white matter enhancement.
154
what is the most sensitive way to detect tryposonoma brucei?
CSF analysis- double centrifugation technique
CSF shws high WCC, elevated IgM and elevated protein level
155
156
Treatment of choice in for Tryposonoma Brucei?
Suramin/Pentamidine in stage 1 (chancre/fever/myalgia)
Melasoprol stage 2 (CNS disease/meingoencephalitis)
157
Indication for Oseltamivir for influenza?
Presentation \< 48 hours + high risk group (i.e diabetes)
158
159
When in the course of the disease is IVIG indicated for botulinum toxin
EARLY PRESENTATION + INGESTED TOXIN BUT ARE ASMPTOMATIC
If late in the disease get urgent anaesthetic review due to respiraotry muscle weakeness
160
what orgaism causes gas gangrene?
Clostridium Perfringens
161
Signs & Symptoms of Gas Gangrene?
Violaceous/black bullae and sweat smelling of green pus
162
Rx for clostridium perfringens?
Benzylpenicillin
163
Most common complication of measles in an adult?
Otitis media
164
Most common cause of death from measles in an adult?
Pneumonia
165
How long after should PEP be started for HIV?
24 to 72 hours of exposure
166
common bacterial cause otitis externa?
pseudomonas otitis externa
167
Rx for otitis externa
Gentamicin drops
sever (i.e perfortion): 7 days of flucloxcacillin (If penicillin allergy then clarithromycin)
