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MRCP Part II > ID > Flashcards

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)

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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

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3
Q

Treatment of Strongyloidiasis

A

Ivermectin/albendazole

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4
Q

Features of Strongyloides Hyperinfection Syndrome (proliferation of larvae in immunosuppression)

A

Paralytic ileus
Sepsis due to gut bacteria translocation
Pulmonary infitrates

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5
Q

Suspect Lyme disease - erythema migrans is present

A

Treat: Doxycyline 14 - 21 days

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6
Q

Suspect Lyme disease - no erythema migrans.

A

ELISA for Borrelia burgdorferi antibodies

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7
Q

Suspect Lyme disease - (no erythema migrans) - Borrelia ELISA serology negative at <4wk since symptom onset

A

Repeat ELISA in 4-6wk

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8
Q

Suspect Lyme disease - (no erythema migrans) - Borrelia serology negative at >12wk since symptom onset

A

Immunoblot

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9
Q

Suspect Lyme disease - (no erythema migrans) - Borrelia ELISA positive

A

Immunoblot test

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10
Q

Suspect Lyme disease - (no erythema migrans) - Borrelia serology equivocal

A

Immunoblot

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11
Q

Management of early Lyme disease - in pregnancy

A

Amoxicillin (doxycycline CI in pregnancy)

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12
Q

Management of disseminated Lyme disease - in pregnancy

A

Ceftriaxone

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13
Q

Monitoring of HIV

A

Viral load every 6m

CD4 count annually

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14
Q

Clostridium botulinum - bacterial identification

A

Gram positive anaerobic bacillus

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15
Q

Management of botulism

A 
Botulism antitoxin (if early) 
Supportive care
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16
Q

Features of leprosy

A

Hypopigmented patches
Anaesthetic nodules
May be symmetrical or asymmetrical nerve involvement
Alopecia

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17
Q

Diagnosis of leprosy

A

Skin biopsy

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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)

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19
Q

Features of Mycoplasma pneumonia

A

Dry cough
Prolonged flu-like
Erythema multiforme
Hyponatraemia
Haemolytic anaemia (cold agglutinins)

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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)

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21
Q

Which drugs risk re-activation of TB

A

TNF inhibitors:
Etanercept
Infliximab

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22
Q

Tests used to diagnose latent TB

A

Quantiferon (IFN-g release assay)
Mantoux

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23
Q

Features of Dengue fever

A

Fever
Severe bone/muscle aches
Retro-orbital headache
Maculopapular rash
Low WCC, low PLT
Haemorrhagic phase

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24
Q

Treatment of Dengue fever

A

Supportive

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25
Q

Features of Scrub typhus

A

Fever + muscle pain
Eschar at mite entry site

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26
Q

Features of Typhoid fever

A

Symptoms occurs 10-20 days following exposure, causes:

High fever

Dry cough

abdomina pain + green diarrhea

Relative bradycardia
Rose spots
Reactive athritis

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27
Q

Features of Chikungunya fever

A

Severe joint pain + swelling
High fevers
Lymphopenia
Thrombocytopenia

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28
Q

Ross River Virus - endemic in

A

Australia

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29
Q

Chikungunya fever - endemic in

A

Africa
Asia
Caribbean

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30
Q

Treatment for schistosomiasis

A

Praziquantel

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31
Q

Treatment for giardiasis

A

1 week Metronidazole
or
3g Tinidazole stat

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32
Q

Cryptococcus meningitis (fungal) - CSF findings

A

Raised opening pressure
Lymphocytosis
High protein
Low glucose

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33
Q

Management of Cryptococcus meningitis

A

Amphotericin B

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34
Q

Treatment for amoebic liver abscess

A

Metronidazole

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35
Q

Treatment of fungal liver abscesses

A

Amphotericin B

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36
Q

Treatment for intestinal amoeba (after treated the liver abscess)

A

Diloxanide furoate

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37
Q

Antibiotic for Legionnaire’s disease

A

Macrolide (clarithromycin/erythromycin) or quinolone (levofloxacin)

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38
Q

Antibiotic treatment of Listeria meningitis

A

IV amoxicillin/ampicillin + gentamicin

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39
Q

Antibiotic treatment of tetanus wound (after debridement and tetanus globulin)

A

Metronidazole IV

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40
Q

1st line management of Brucellosis

A

Oral doxycycline + rifampicin

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41
Q

Management of Brucellosis with neurological involvement

A

IV Ceftriaxone + doxycycline + rifampicin

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42
Q

Management of brucellosis with endocarditis

A

Gentamicin + doxycycline + rifampicin

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43
Q

Presentation of Yersinia enterocolitica

A

Pseudo-appendicitis
Reactive arthritis
Erythema nodosum

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44
Q

Treatment of Yersinia

A

Aminoglycoside (gentamicin)

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45
Q

Treatment of salmonella typhi

A

ceftriaxone

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46
Q

DIffuse macular/papular/nodular rash with discoloration, after treatment for visceral leishmaniasis

A

Post-kala-azar dermal leishmaniasis (PKDL)

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47
Q

Visceral leishmaniasis “kala-azar” (spread by sand fly) - endemic in

A

Mediterannean, Middle East, Asia, Africa, S. America,

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48
Q

Features of Giardiasis

A

Prolonged diarrhoea >10days
Bloating, abdo pain
Non-bloody

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49
Q

Farmer, with fever, pneumonia, transaminitis, think…

A

Q fever (Coxiella burnetii)

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50
Q

Treatment of Q fever (Coxiella)

A

Doxycycline

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51
Q

Management of mild PCP

A

Co-trimoxazole

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52
Q

Management of moderate/severe PCP
(eg diffuse shadowing on CXR/ low sats/ breathless at rest),

A

Co-trimoxazole + corticosteroids

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53
Q

What does a positive IGRA (interferon-gamma release assay) indicate?

A

Active or latent TB

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54
Q

What might positive Mantoux test (induration 6-15mm) indicate?

A

Latent TB
Miliary TB
Sarcoidosis
HIV
Lymphoma

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55
Q

Antibiotic used for Shigella (if needed)

A

CIprofloxacin

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56
Q

Antibiotic used for Campylobacter (if needed)

A

Ciprofloxacin

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57
Q

Antibiotic used for Cholera (if needed)

A

A tetracycline

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58
Q

Features of Brucellosis

A

Fever, malaise
Sacroiliitis
Contact with sheep/goats
or animal products in Med/Middle East

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59
Q

Features of malaria

A

Fever, myalgia
Jaundice
Hepatosplenomegaly

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60
Q

Features of viral haemorrhagic fevers (Yellow fever, Dengue, Ebola, Lassa)

A

Prodrome
Anaemia, thrombocytopenia
Renal failure
DIC

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61
Q

Treatment of uncomplicated Falciparum malaria

A

“ACT” Artemisinin-based combination therapy (eg artesunate plus mefloquine)

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62
Q

Treatment of severe/complicated Falciparum malaria

A

IV artesunate
Exchange transfusion if parasite count >10%

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63
Q

Who needs to be treated for non-typhoidal salmonella gastroenteritis?

A

>50 years old and:
Immunocompromised
Valve disease
Endovascular abnormality

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64
Q

Features of Yellow fever

A

Fever + malaise
Jaundice
Conjunctival injection
Relative bradycardia

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65
Q

Councilman bodies in hepatocytes - seen in which disease

A

Yellow fever

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66
Q

Antibiotics used to treat carbapenemase producing enterobacteriaceae (CPE)

A

Gentamicin (macrolide)
Tigecycline
Fosfomycin
Colistin

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67
Q

Treatment of typhoid fever

A

Cefotaxime/ceftriaxone

68
Q

Features of Visceral Leishmaniasis (kala-azar)

A

Fevers
Hepatosplenomegaly
Pancytopenia
Grey skin

69
Q

Gold standard test for visceral leishmaniasis

A

Bone marrow or splenic aspirate (amastigote parasites)

70
Q

Confusion in returned traveller from Asia, think

A

Japanese encephalitis

71
Q

HIV positive with headache and neurological symptoms, think…

A

CNS cryptococcus

72
Q

Test for Cryptococcus

A

India ink

73
Q

Treatment of CNS cryptococcal infection

A

IV amphotericin B + flucytosine

74
Q

Treatment of staph aureus bactaraemia

A

At least 2 weeks of IV Flucloxacillin

75
Q

Features of acute schistosomiasis infection

A

Cough
Bloody diarrhoea
Eosinophilia
Splenomegaly

76
Q

Diagnosis of intestinal Cryptosporidium parvum (protozoan)

A

Cysts seen on acid-fast stain of stool culture

77
Q

Indication for varicella-zoster immunoglobulin (VZIG)

A

Should be given within 7 days of exposure to:
Immunosuppressed
Neonates
Pregnant without varicella antibodies

78
Q

Management of chickenpox in immunocompromised individuals (once developed chickenpox)

A

IV aciclovir

79
Q

Fever on alternate days - suggestive of

A

P. vivax or P. ovale malaria

80
Q

Treatment of plasmodium vivax malaria

A

Chloroquine + primaquine (for hyponozoites)

81
Q

Gold standard diagnostic test for strongyloidiasis

A

Stool microscopy

82
Q

Best test for strongyloidiasis eradication

A

Serological testing

83
Q

Management of low-severity community acquired pneumonia

A

Amoxicillin 5 days

84
Q

Management of low-severity community acquired pneumonia (pen-allergic)

A

Macrolide (clarithromycin) or tetracycline 5 days

85
Q

Management of moderate severity community acquired pneumonia

A

Amoxicillin + macrolide 7-10 days

86
Q

Management of high severity community acquired pneumonia

A

Co-amoxiclav (or ceftriaxone/tazocin) + macrolide

87
Q

CURB-65 score - 1 point for C if

A

AMTS <= 8/10

88
Q

CURB-65 score - 1 point for U if

A

Urea > 7

89
Q

CURB-65 score - 1 point for R if

A

RR >= 30

90
Q

CURB-65 score - 1 point for B if

A

Systolic <= 90 or diastolic <= 60

91
Q

Management of CURB-65 score 2+

A

Consider hospital admission

92
Q

Management of CURB-65 score 3+

A

Consider ITU

93
Q

Which HIV patients should receive PCP (pneumocystis carinii) prophylaxis

A

All those with CD4 count <200/mm

94
Q

Which non-HIV patients should receive PCP prophylaxis

A

Transplant recipients (solid organ or stem cell)

Taking steroids + another immunosuppressant for >1m

AI condition with lung involvement + high dose steroid >1m

95
Q

Diagnosis of PCP

A

Broncho-alveolar lavage - shows cysts with silver staining

96
Q

Initial empirical treatment for meningitis if <3 months old

A

IV cefotaxime + amoxillin/ampicillin)

97
Q

Initial empirical treatment for meningitis if 3 months - 50 years old

A

IV cefotaxime/ceftriaxone

98
Q

Initial empirical treatment for meningitis if >50 years old

A

IV cefotaxime/ceftriaxone + amoxicillin/ampicillin

99
Q

Treatment of meningococcal meningitis

A

IV benzylpenicillin
or
IV cefotaxime/ceftriaxone

100
Q

Treatment of pneumococcal meningitis

A

IV cefotaxime/ceftriaxone

101
Q

Treatment of meningitis caused by Haemophilus influenzae

A

IV cefotaxime/ceftriaxone

102
Q

Treatment of meningococcal meningitis (pen-allergic)

A

Chloramphenicol

103
Q

Treatment of meningitis caused by Haemophilus influenzae (pen-allergic)

A

Chloramphenicol

104
Q

Haemophilus influenzae appearance under microscope

A

Gram-negative coccobacilli

105
Q

Chlamydia trachomatis gram-stain

A

Gram-negative coccobacilli

106
Q

Management of close contacts of meningococcal meningitis (close contact within the 7 days before onset)

A

PO ciprofloxacin STAT
or PO Rifampicin BD 2 days
or IM ceftriaxone

Meningococcal vaccination when serotype availabe

107
Q

Which tick carries Babesia?

A

Ixodes Tick

108
Q

What are the haematological symptoms/complications of Babesia?

A

Haemoglobinuria
Jaundice (haemolytic anaemia)
Hyergammaglonimaemia

NB: Higher risk of symptoms in sickle cell disease/asplenia patients

109
Q

Symtoms of Babesiosis?

A

Irregularly cycling FEVERs

110
Q

Diangosis for Babesia?

A

Blood smear (maltese cross)- cross is from a tetrad of trophozoites

111
Q

Treatment for Babseia?

A

Oral Atovaquone and Oral Azithromycin

Immunocompromised= IV azithromycin and oral atovaquone

ALternative: IV clindamycin and oral quinine

112
Q

Indication for exchange transfusion in patients with severe babseia?

A 
High grade parasitemia (\>10%) 
severe haemolysis (Hb \<10) 
organ dysfunction (pulmonary, renal, liver)
113
Q

Patient bitten by stray dog and has never been given prophylaxis for rabies. Rx?

A

Vaccination:

  • Day of presentation
  • Days 3,7,14,30
  • IVIG
114
Q

What is Katayama fever?

A

Manifestation of acute shcistosomiasis; features include urticarial rash, hepatpsplenomegaly and bronchospasm

115
Q

1st and 2nd line Rx of genital warts

A

1) Podophyllotoxin ointment
2) cryotherapy

116
Q

Burcellosis-transmission?

A

Ingestion of contaminated food products, especially unpasteurised milk

117
Q

Burcellosis; symptoms?

A

Weight loss, bone pain, splenomegaly and parodoxical bradycardia, neutropenia, thrombocytopenia

118
Q

Brucellosis gold standard investigation?

A

Bone marrow aspirate and culture (facultative intracellular organism)

119
Q

Brucellosis Treatment?

A

Doxycycline + Streptomycin/Rifampicin for 6 weeks

120
Q

Commonly isolated orgnaism from human bites?

A

Streptococcus, Staphylococcus, Haemophilus, Bacteriodes and Eikenlla?

121
Q

Presentation of Echinococcus?

A

Hydatid Cyst, flu like symptoms, Nausea/Vomtiing, boating, abdominal pain, billiary dysfunction (jaundice)

122
Q

Rx of Echinococcus?

A

Albendazole

123
Q

Symptoms of Salmonella Typhi other than rose spots?

A

Fever, Myalgia, headache Dry Cough, Heapto-Splenomegaly

124
Q

Incubation period of salmonella typhi?

A

3 weeks

125
Q

Symptoms of Mycobacterium Avium?

A

Respiratory symptoms, weight loss, diarrhoea, generalised lymphadenopathy and abnormal LFTs

126
Q

Who is at risk of norcardia?

A

Immunocompromised (steroids, HIV, transplant patients)

127
Q

Symptoms of Norcardia?

A

Respiratory: Pneumonia/cavitaing lesions

Neurological: brain abscess

Skin: indurated skin lesions

128
Q

Rx for Norcardia?

A

Sulphadiazine

129
Q

Rx for Diptheria?

A

Diptheria antitoxin + Abx (erythromycin)

130
Q

Major complication of Diptheria?

A

Myocarditis

131
Q

When is a Nucleic Acid Amplification test (NAAT) used?

A

When suspective/looking for Gonococcus or Chlamydia

132
Q

What is Yaws?

A

Caused by Treponema Pertenue. Similar to Syphyllis. Transmitted skin to skin contact. PResentation is one or multiple skin lesions which may ulcerate.

133
Q

What is a risk factor for anthrax?

A

Infected carcasses

134
Q

What is the presentation of anthrax?

A

Initial pustule at site of infection which progress to form BLACK ESCHAR

135
Q

Presentation of loa loa?

A

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
Q

Signs and symptoms of entomebea histolytica?

A

constitutional symptom of myalgia and fever

hepatomegaly and pleural effusion (cough)

137
Q

What is the clinical presentation of yersinia?

A

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
Q

What is the treatment for Filiariasis?

A

1st line- Diethylcarbamazine (DEC)

But if high parasitic load- 2nd line is Ivermectin

139
Q
A
140
Q

Diagnosis and Treatment for Typhoid Fever?

A

Blood cultures for diagnosis

Azithromycin for treatement (Ceftriaxone if severe)

141
Q

Describe the typical onset of features for Weil’s Disease

A

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
Q

Rx for Infective Endocarditis caused by Bacillus Cereus

A

Vancomycin

143
Q
A
144
Q
A
145
Q

Molluscum contagiosum in adults should raise suspicion of what?

A

HIV

146
Q

Management of optic neuropathy secondary to Ethambutol?

A

Stop the medication and urgent ophtalmology opinion

147
Q

What are the 2 classification of leprosy?

A

Lepromatuous Leprosy

Tuberculoid leprosy

148
Q

What determines the type of leprosy

A

DEGREE OF CELL MEDIATED IMMUNITY

LOW DEGREE = LEPROMATOUS

HIGH DEGREE = TUBERCULOID

149
Q

Features of lepromatous leprosy (multibacilary)

A

extensive skin involvement (hence the term MULTIbacillary)

symmetrical nerve invovlement

involvement of kidneys, genitals, nose and mouth

MOST CONTAGIUS

150
Q

Features of tuberculoid leprosy?

A

limited skin disease

asymmetric nerve invovlement

hair loss

151
Q

Features of Trypanosoma Brucei Rhodesiense?

A

Erythematous swelling or chancre at site of fly bite 5-15 days later

fever, headache, myalgia

THEN PROGRESSES to meningoencephalitis

daytime somloence

152
Q

Investigations for Tryposonoma Bruceir Rhodesiense?

A

CT of head prior to LP

153
Q

What will CT/MRI head show in infection with tryposonoma brucei rhodesiense

A

Late disease shows cerebral oedema and white matter enhancement.

154
Q

what is the most sensitive way to detect tryposonoma brucei?

A

CSF analysis- double centrifugation technique

CSF shws high WCC, elevated IgM and elevated protein level

155
Q
A
156
Q

Treatment of choice in for Tryposonoma Brucei?

A

Suramin/Pentamidine in stage 1 (chancre/fever/myalgia)

Melasoprol stage 2 (CNS disease/meingoencephalitis)

157
Q

Indication for Oseltamivir for influenza?

A

Presentation < 48 hours + high risk group (i.e diabetes)

158
Q
A
159
Q

When in the course of the disease is IVIG indicated for botulinum toxin

A

EARLY PRESENTATION + INGESTED TOXIN BUT ARE ASMPTOMATIC

If late in the disease get urgent anaesthetic review due to respiraotry muscle weakeness

160
Q

what orgaism causes gas gangrene?

A

Clostridium Perfringens

161
Q

Signs & Symptoms of Gas Gangrene?

A

Violaceous/black bullae and sweat smelling of green pus

162
Q

Rx for clostridium perfringens?

A

Benzylpenicillin

163
Q

Most common complication of measles in an adult?

A

Otitis media

164
Q

Most common cause of death from measles in an adult?

A

Pneumonia

165
Q

How long after should PEP be started for HIV?

A

24 to 72 hours of exposure

166
Q

common bacterial cause otitis externa?

A

pseudomonas otitis externa

167
Q

Rx for otitis externa

A

Gentamicin drops

sever (i.e perfortion): 7 days of flucloxcacillin (If penicillin allergy then clarithromycin)

MRCP Part II (15 decks)

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