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1
Q

What is seen on CSF analysis in bacterial meningitis?

A

Cloudy appearance
Low glucose (50% plasma)
High protein
10-5000 PMNs

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2
Q

What is seen on CSF analysis in viral meningitis?

A

Glucose 60-80% plasma
Normal/high protein
15-1000 lymphocytes

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3
Q

What is seen on CSF analysis in tuberculous meningitis?

A

Slightly cloudy, fibrin web
Low glucose (50% plasma)
High protein
30-300 lymphocytes

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4
Q

What is the treatment of TB meningitis?

A

Usual therapy + prednisolone

12 months

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5
Q

What is the most common cause of viral meningitis?

A

Enterovirus e.g. Coxsackie

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6
Q

Which lobes does HSV-1 encephalitis affect?

A

Temporal and frontal

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7
Q

How is HSV encephalitis diagnosed?

A

LP - viral CSF picture
PCR for HSV
CT: medial temporal and inferior frontal petechial haemorrhages
EEG: lateralised periodic discharges at 2Hz

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8
Q

What is the cause of Japanese encephalitis and how is it transmitted?

A

Flavivirus
Transmitted by culex mosquitos which breed in rice paddy fields
Reservoir hosts - aquatic birds
Amplification hosts - pigs

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9
Q

What are the symptoms of Japanese encephalitis that differentiate it from other forms of encephalitis?

A

Parkinsonian features

Acute flaccid paralysis

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10
Q

What type of virus is hepatitis B?

A

dsDNA hepadnavirus

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11
Q

Which is the first serological marker to appear in hepatitis B and indicates ongoing infection?

A

HBsAg

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12
Q

What are the characteristics of anti-HBs?

A

Implies immunity - exposure or immunisation

Negative in chronic disease

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13
Q

What are the characteristics of anti-HBc?

A

Present for around 6 months; implies previous or current infection
Negative if immunised (c=caught)

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14
Q

What hepatitis serology is expected to be seen in patients who have only been immunised against hepatitis B?

A

Anti-HBs

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15
Q

What are the complications of hepatitis B?

A

Chronic hepatitis and fulminant liver failure
Glomerulonephritis
Polyarteritis nodosa
Cryoglobulinaemia

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16
Q

What level of anti-HBs shows adequate response to vaccination?

A

> 100

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17
Q

What are the features of chronic hepatitis B?

A

Transaminitis
Ground glass appearance of liver
HBsAg and anti-HBc

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18
Q

What is the treatment of chronic hepatitis B?

A

48 weeks pegylated IFN-a

Synthetic thymidine nucleoside analogue e.g. tenofovir, entecavir

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19
Q

What type of virus is hepatitis C?

A

RNA flavivirus

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20
Q

What is the serology of hepatitis C?

A

HCV RNA detected

anti-HCV antibodies (remain if patients clear the virus)

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21
Q

What percentage of patients clear hepatitis C?

A

33%

66% develop chronic hepatitis C, 50% of these develop end stage liver disease

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22
Q

What are the risk factors for developing chronic hepatitis C?

A

Asymptomatic in acute stage
Co-existing hepatic pathology
HIV
African American

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23
Q

What are the complications of chronic hepatitis C?

A 
Arthritis
Sjogren's syndrome
Cirrhosis and HCC
Type 2 cryoglobulinaemia
PCT
Membranoproliferative GN
Autoimmune thyroid disease
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24
Q

What does management of hepatitis C depend on?

A

Viral genotype

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25
Q

What is the treatment of hepatitis C?

A

2DAAS +/- ribavarin

E.g. Harvoni (ledipasvir (NS5A inhibitor) and sofosbuvir (NS5B inhibitor)

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26
Q

What is HCC screening in hepatitis C?

A

6 monthly AFP, liver USS

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27
Q

In which patients does hepatitis E carry risk of significant mortality?

A

Pregnancy

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28
Q

What is the mechanism of action of rifampicin?

A

Inhibits bacterial DNA dependent RNA polymerase, preventing transcription of DNA into mRNA

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29
Q

What are the side effects of rifampicin?

A

Hepatitis
Orange/pink secretions
Flu like
P450 inducer

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30
Q

What is the mechanism of action of isoniazid?

A

Inhibits mycolic acid synthesis

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31
Q

What are the side effects of isoniazid?

A

Peripheral neuropathy (prevent with pyridoxine)
Hepatitis
Agranulocytosis
P450 inhibitor

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32
Q

What is the mechanism of action of pyrazinamide?

A

Converted into pyrazinoic acid which inhibits fatty acid synthase

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33
Q

What are the side effects of pyrazinamide?

A

Hyperuricaemia
Arthralgia/myalgia
Hepatitis

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34
Q

What is the mechanism of action of ethambutol?

A

Inhibits arabinosyl transferase which polymerises arabinose into arabian

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35
Q

What are the side effects of ethambutol?

A

Retrobulbar optic neuritis

Needs dose adjustment in renal impairment

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36
Q

Name 5 skin disorders associated with TB.

A 
Lupus vulgaris
Erythema nodosum
Scarring alopecia
Scrofuloderma
Verrucosa cutis
Gumma
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37
Q

What is the general treatment of HIV?

A

2NRTIs + PI/NRTI

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38
Q

Give some examples of NRTIs and their side effects.

A

Zidovudine: anaemia, myopathy, black nails
Tenofovir: renal impairment, osteoporosis

General: peripheral neuropathy

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39
Q

Give some examples of NNRTIs and their side effects.

A

Nevirapine, efavirenz

P450 induction, rashes

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40
Q

Give some examples of protease inhibitors and their side effects.

A

Ritonavir: P450 inhibitor
Indinavir: renal stones, high bilirubin

General: diabetes, hyperlipidaemia, buffalo hump and central obesity

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41
Q

Give some examples of integrase inhibitors.

A

Raltegravir, elvitegravir

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42
Q

What is the cause of progressive multifocal leukoencephalopathy?

A

Infection of oligodendrocytes by JC virus

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43
Q

What is seen on CT or MRI in PML?

A

Widespread demyelination, single/multiple lesions

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44
Q

What is seen on CT in cerebral toxoplasmosis?

A

Single or multiple ring enhancing lesions

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45
Q

What is the treatment of cerebral toxoplasmosis?

A

Sulfadiazine and pyrimethamine

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46
Q

Which virus is primary CNS lymphoma associated with?

A

EBV

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47
Q

Which imaging modality is positive in primary CNS lymphoma?

A

Thallium SPECT

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48
Q

How is cryptococcal meningitis diagnosed?

A

High opening pressure CSF, India ink test positive

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49
Q

What is the cause of AIDs dementia?

A

HIV virus itself

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50
Q

What is post exposure prophylaxis?

A

Combo PO antiretrovirals for 4 weeks

Serological testing at 12 weeks post completion

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51
Q

What are the symptoms of HIV seroconversion illness?

A

Glandular fever type
1-4 weeks after infection
Maculopapular rash

Suggests the beginning of HIV antibody production

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52
Q

What is tested in suspected HIV seroconversion illness?

A

P24 antigen

HIV PCR

Antibodies negative up to 3 months

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53
Q

Which HIV patients should have prophylaxis against PCP pneumonia?

A

CD4 count <200

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54
Q

How is PCP pneumonia diagnosed?

A

CXR: bilateral interstitial pulmonary infiltrates
BAL silver staining: cysts
Sputum culture

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55
Q

What is the treatment of PCP pneumonia?

A

Co-trimaxazole

IV pentamidine if severe

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56
Q

If PCP patients are hypoxic <9.3kPa, what is added to treatment?

A

Steroids

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57
Q

What type of virus is HIV?

A

RNA retrovirus

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58
Q

Which cells does HIV virus infect?

A

CD4 T cells, macrophages, dendritic cells

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59
Q

How does HIV virus replicate?

A

After entering a cell, reverse transcriptase creates dsDNA from RNA for integration into the host cell’s genome

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60
Q

Which vaccines are contraindicated in HIV?

A

Cholera
Intranasal influenza
Oral polio
BCG

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61
Q

How is latent TB diagnosed, and when is a false negative likely?

A

Mantoux skin test –> if positive then IFN-gamma blood test used.

Mantoux test false -ve: miliary TB, sarcoid, lymphoma, HIV, <6 months

62
Q

How is active TB diagnosed?

A

3x sputum culture

More sensitive than sputum smear with Ziehl-Neelson stain

63
Q

What is the treatment of active TB?

A

Rifampicin and isoniazid for 6 months

Pyrazinamide and ethambutol for first 2 months

64
Q

What is the treatment of latent TB?

A

3 months isoniazid and rifampicin, or 6 months isoniazid

65
Q

What are the features of strep pneumonia CAP?

A

Rapid onset
High fever
Pleuritic chest pain
Herpes labialis

66
Q

What are the causes of infectious mononucleosis?

A

EBV or HH4

67
Q

How is infectious mononucleosis diagnosed?

A

Atypical lymphocytes
Transient rise in ALT
Haemolytic anaemia secondary to cold agglutins (IgM)
Maculopapular rash after amoxicillin

68
Q

What is the cause of anthrax and how does it cause disease?

A

Bacillus anthracis (gram +ve rod)

Produces tripartite protein toxin: protective factor, oedema factor (increased cAMP) and lethal factor (which is toxic to macrophages)

69
Q

What are the features of anthrax?

A

Painless black eschar which can cause oedema, compartment syndrome, fever
Necrotising fasciitis
GI bleeding

70
Q

What is the treatment of anthrax?

A

Ciprofloxacin

71
Q

What is the reaction caused by release of endotoxins following bacterial death after first dose of antibiotics?

A

Jarisch-Herxheimer reaction

72
Q

What is the treatment of lassa fever?

73
Q

How is dengue fever transmitted?

A

Aedes aegypti mosquito

74
Q

What are the symptoms of dengue fever?

A

Retro-orbital headache
Fever, myalgia
Facial flushing and maculopapular rash

75
Q

What may Dengue fever progress to?

A

Dengue haemorrhagic fever (form of DIC) –> dengue shock syndrome

76
Q

What are the features of Chikungunya fever?

A

Rapid fever
Debilitating joint pain
Palmar/plantar rash

77
Q

What are the features of Lassa fever?

A

Mucosal bleeding

Mastomys rodent

78
Q

What are the features of Yellow fever?

A

5 day duration

Non specific symptoms

79
Q

What are the features of leprosy?

A

Hypopigmented skin with sensory loss

Lepromatous leprosy/multibacillary: extensive, symmetric nerve involvement

Tuberculoid leprosy/paucibacillary: limited skin disease, asymmetric nerve involvement

80
Q

What determines severity of leprosy?

A

Degree of cell mediated immunity

81
Q

What is the treatment of leprosy?

A

Rifampicin, dapsone, clofazimine

82
Q

How does the rabies virus cause disease?

A

Animal bite –> virus travels up nerve axons towards CNS

83
Q

What are the features of rabies?

A

Prodromal headache/fever
Hydrophobia and muscle spasms
Hypersalivation

84
Q

What is seen in infected neurons in rabies?

A

Negri bodies (cytoplasmic inclusion bodies)

85
Q

What is the treatment of rabies?

A

2 further doses of vaccine

If not vaccinated, human rabies Ig with full vaccine course

86
Q

What are the features of typhoid?

A

Relative bradycardia
Abdo pain and distension
Rose spots

87
Q

How is typhoid diagnosed?

A

Large volume blood culture

88
Q

What are the 3 serotypes of e coli?

A

O - lipopolysaccharide layer
K - capsule
H - flagellin

89
Q

Which type of e.coli causes neonatal meningitis?

90
Q

Name some gram +ve bacteria.

A

Cocci - staph + strep

Bacilli - anthrax, listeria, diphtheria, clostridium

91
Q

Name some gram -ve bacteria.

A

Cocci - neisseria, moraxella

Bacilli - e.coli, hib, pseudomonas, salmonella, shigella

92
Q

What are the 7 live attenuated vaccines?

A 
BCG
MMR
Intranasal influenza
Oral rotavirus
Oral polio
Yellow fever
Oral typhoid
93
Q

What is the mechanism of action of aciclovir?

A

Guanosine analogue, phosphorylated by thymidine kinase which inhibits viral DNA polymerase

94
Q

What is a side effect of aciclovir?

A

Crystalline nephropathy

95
Q

What is the pathophysiology of botulism?

A

Clostridium botulinum produces botulinum toxin, a neurotoxin which irreversibly blocks the release of ACh

96
Q

What are the features of botulism?

A

Fully conscious with no sensory disturbance
Flaccid paralysis
Bulbar palsy
Dysarthria, diplopia, ataxia

97
Q

What is the treatment of botulism?

A

Botulism antitoxin

98
Q

What is Lemierre’s syndrome?

A

Thrombophlebitis of the internal jugular vein secondary to peritonsillar abscess –> septic PE

99
Q

What is the pathophysiology of diphtheria?

A

Corynebacterium diphtheria releases exotoxin encoded by b-prophage, which inhibits protein synthesis by catalysing ADP-ribosylation of elongation factor EF2

100
Q

What are the features of diphtheria?

A

Diphtheric membrane on tonsils
Cervical lymphad
Neuritis
Heart block

101
Q

What is the treatment of diphtheria?

A

IM penicillin

Diphtheria antitoxin

102
Q

What are the 2 reproductive cycles in falciparum malaria?

A

Exo-erythrocytic cycle in hepatocytes

Erythrocytic cycle in red blood cells

103
Q

What are the features of falciparum malaria?

A 
Schizonts on blood film
Parasitaemia >2%
Hypoglycaemia
Acidosis
Fever>39
Severe anaemia
104
Q

What are schizonts on blood film?

A

Indicates imminent schizogony and consequentially significant rise in parasitaemia

105
Q

What is Blackwater fever?

A

Acute renal failure secondary to large intravascular haemolysis

Urine black/dark red (haemoglobinuria)

106
Q

What is the treatment of falciparum malaria?

A

Uncomplicated: ACTs e.g. artesunate + mefloquine

Complicated: IV artesunate

107
Q

What is the treatment of severe parasitaemia >10% in falciparum malaria?

A

Exchange transfusion

108
Q

What is the most common type of non falciparum malaria?

109
Q

What are the characteristics of knowlesi malaria?

A

Very fast erythrocytic cycle (24 hours) with end stage involves lysis of RBCs and release of additional parasites

Therefore produces very high parasite counts in a short space of time

110
Q

Which malaria is associated with nephrotic syndrome?

111
Q

What is the treatment of non falciparum malaria?

A

Chloroquine (unless resistant - ACT)

112
Q

What medication is added in vivax/ovale malaria and why?

A

Primaquine

To destroy liver hypnozoites and prevent relapse

113
Q

What is the cause and risk factor for melioidosis?

A

Gram -ve burkholderia pseudomallei in East Asia and Northern Australia

RF: diabetes

114
Q

What is the treatment of melioidosis?

A

10 days IV ceftazidime/carbapenem

Followed by 20 weeks oral maintenance phase

115
Q

What is the cause of traveller’s diarrhoea?

A

Enterotoxigenic e.coli

116
Q

What are the features of amoebiasis?

A

Long incubation

RUQ pain - liver abscess with anchovy sauce aspirate

117
Q

What is the treatment of amoebiasis?

A

Metronidazole and tinidazole, followed by luminal amoebicide (diloxanide furoate)

118
Q

How is leptospirosis spread?

A

Infected rat urine

119
Q

What are the early features of leptospirosis?

A

Fever, flu like, subconjunctival injection

Lasts a week

120
Q

What are the features of second immune phase of leptospirosis (Weil’s disease)?

A

AKI
Hepatorenal syndrome
Aseptic meningitis

121
Q

What is the treatment of leptospirosis?

A

High dose ben pen or doxy

122
Q

What is the cause of Q fever?

A

Coxiella burnetti

123
Q

Rickettsia ricketsii causes which illness?

A

Rocky mountain spotted fever

124
Q

What are the features of endemic typhus?

A

Rickettssi typhi
Flea vector
Central rash –> peripheral

125
Q

What are the 2 forms of trypanosomiasis and what are they spread by?

A

African (sleeping sickness) –> tsetse fly

American (Chagas disease) –> triatomine bug

126
Q

What are the features of African trypanosomiasis?

A

Intermittent fever
Trypanosoma chancre
Posterior cervical lymphad
Somnelence, reversal of sleep-wake cycle

127
Q

What is the treatment of African trypanosomiasis?

A

IV pentamidine/suramin

If CNS involvement: IV melarosprol

128
Q

What is the Romana sign?

A

Chagoma and periorbital oedema seen in acute phase of American trypanosomiasis

129
Q

What are the chronic features of Chagas’ disease?

A

Myocarditis + dilated cardiomyopathy

Megaoesophagus and megacolon

130
Q

What spreads leishmaniasis?

A

Sandfly bite

131
Q

What are the 3 forms of leishmaniasis?

A

Cutaneous
Mucocutaneous
Visceral

132
Q

What are the features of visceral leishmaniasis?

A 
Caused by leishmania donovani
Fevers, rigors
Massive splenomegaly and hepatomegaly
Weight loss
Grey skin (kala-azar)
Pancytopenia
133
Q

How does toxoplasma gondii cause disease?

A

Oocysts release trophozoites which migrate around the body including to the eye, brain or muscle

134
Q

What are the forms of toxoplasmosis?

A

Immunocompetent: asymptomatic/self limiting
HIV: cerebral/chorioretinitis
Congenital (transplacental spread): neuro and ophthalmic damage

135
Q

What is the pathognomonic rash of strongyloidiasis?

A

Larvae currens

136
Q

What is the treatment of strongyloidiasis?

A

Ivermectin

137
Q

What is Katayama fever?

A

Acute schistosomiasis syndrome - fever, urticaria, arthralgia, cough, diarrhoea, eosinophilia

138
Q

Which form of schistosoma causes terminal haematuria and is a risk factor for squamous cell bladder cancer?

A

Schistosoma haematobiu,

139
Q

What do schistosoma mansoni and japonicum do?

A

Mature in the liver
Travel through the portal system to inhabit the distal colon
Cause hepatosplenomegaly, portal vein congestion, cor pulmonale

140
Q

What is the commonest cause of visceral larva migrans?

A

Toxocara canis

141
Q

Which tapeworm causes cysticercosis and what is the treatment?

A

Taenia solium

Niclosamide

142
Q

What is the treatment of schistosomiasis?

A

Praziquantel

143
Q

What is the cause of a painless ulcer (chancre)?

A

Syphilis

Treponema pallidum

144
Q

What is the cause of a painful chancroid with ragged border?

A

Haemophilus ducreyi

145
Q

What disease does chlamydia trachomatis cause?

A

Lymphogranuloma venereum

146
Q

What are the stages of lymphogranuloma venereum?

A

Small painless ulcer
Painful inguinal lymphad
Proctocolitis

147
Q

What is the treatment of LGV?

A

Doxycycline

148
Q

What is the cause of granuloma inguinale?

A

Klebsiella granulomatis

149
Q

What is the treatment of PID?

A

PO olfloxacin + PO metro

OR

IM ceftriaxone + PO doxy + PO metro

150
Q

What is the treatment of chlamydia?

A

7 days doxycycline

151
Q

What is the treatment of gonorrhoea?

A

IM ceftriaxone 1g

MRCP (17 decks)

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