ID Flashcards
1
Q
2 conditions to delay ART in HIV
A
Tuberculous meningitis
Cryptococcus meningitis
2
Q
Window period for HIV - how long, why, how to overcome
A
First 2-4 weeks, No Ab formation, can’t test for on ELISA
New tests pick up p24, or can test for VL (high within 5 days)
3
Q
A/E to tenofovir
A
Nephrotoxicity
Myelosuppresion
4
Q
WHich tenofovir has higher A/E profile
A
TDF higher ris
5
Q
A/E of Abacavir
A
Hypersensitivity to HLA-B57*01
6
Q
HIV treatment with depression/CNS toxicity in first few weeks
A
Efavirenz
7
Q
HIV medication highest risk of SJS
A
Nevirapine
8
Q
Integrase inhibitors - how to identify, A/E
A
Gravir
Weight gain
9
Q
CCR5 antagonist
A
Maraviroc. Not useful as HIV can switch to binding CCR4
10
Q
lamuvidine A/E
A
Lamuvidine - pancreatitis
11
Q
When to use PRed in PJP pneumonia
A
PaO2 70 –> use Pred in addition to bactrim
12
Q
CMV manifestations in HIV
A
Retinitis - Opthal
Colitis - inclusion bodies
CNS disease
13
Q
Causes of enhancing CNS lesions in HIV
A
Toxoplasmosis
- +ve serology, enhancing lesions, CD4 <200
- Rx - bactrim
Primary CNS lymphoma
- CD4 < 50
14
Q
Viral association Karposi’s
A
HHV8
15
Q
Binding and fusion of HIV - important proteins
A
Binding - GP120 and GP41
FUsion - CCR5/CXCR4 coreceptors
16
Q
HIV in pregnancy
A
Mothers - ART
At delivery
- C section
- VL > 1000 –> Anti-HIV IgG
17
Q
PEP timeline
A
Must be < 72 hours
18
Q
PEP for known source
A
Sexual
- VL +ve = ART for 28 days, VL- = leave
Occupational
- VL +ve - ART for 28 days
- VL -ve - x2 drugs for 28 days
19
Q
PEP unknown source
A
x2 drugs 28 days
20
Q
Elevated opening pressure
A
Cryptococcus meningitis
20
Q
Management of PJP
A
Bactrim
Pred if PaO2 < 70
21
Q
Treatment of syphilis
A
Benziathine penicillin (long acting)
22
Q
Rx of gonorrhoea
A
Ceftriaxone and azithromycin
23
Q
Rx of chlamydia
A
Doxycyline
Can use azithromycin as alternative
24
Immunocompromsied, fevers, blistering rash, neutrophilic infiltrate on biopsy
Sweet's syndrome
25
Gram positive diplococci
S pneumoniae
26
Gram negative diplococci
N meningitidies
27
Gram positive rods
BLANC
Bacillus
Listeria
Actinomyces
Nocardia
CLostridia/Corynebacteria
28
Gram negative coccoid rods
H influenzae
Bordatella pertussis
29
Ecythema gangrenosum cause
Pseudomonas
30
Treatment of cryptococcus
L-amb + 5FC (2 weeks)
8 week tail fluconazole
31
Treatment of invasive aspergillus
Voriconazole
32
Filamentous gram +ve rods (2)
Nocardia
Actinomyces
Nocardia is acid fast positive and grows well in aerobic conditions
33
Presentations of Nocardia
Pulmonary
CNS - parenchymal abscess
Cutaneous
34
Rx of nocardia
Bactrim
35
Neutropenic patient, abdo pain, bowel wall thickening and mucosal enhancement?
Typhilitis
36
RIsk factors for PTLD
EBV serostatus
Degree of immunosuppression
37
1st line treatment for PTLD
Lower immunsuppression
38
Pathophys of PTLD and 2nd line treatments
Aberrant clonal EBV positive B cell proliferation due to excessive T cell suppression
Rx - CD20 depletion (rituximab)
39
Daptomycin ineffective in?
Lungs - inactivated by surfactant
40
What to do with ABx in pneumococcal resistance?
Treatment failure rare, usually have SIE for MIC so increase dose
41
Proteus what?
Citrobacter what?
In ESCAPPM
Proteus Vulgaris
Citrobacter freundii
42
Gene transfer through direct cell to cell contact, usually through sex pillus
Conjugation
43
Transfer of genetic material between bacteria by means of viral vector
Transduction
Vector called bacteriophage
44
Amb Class B CRO
- Example
- WHere?
NDM-1
New Dehli
45
Amber Class C
- Example
AmpC enzymes
ESCAPPM organisms
46
Oxa-48 B lactams - ?where
North Africa and Mediterranean
47
CRE most common in USA
KPC
48
Management of CRO
Colitistin + tigecycline + 3rd agent
49
Recurrent viral self resolving viral meningitis - cause?
Mollaret's
HSV-2
50
Which conditions would be indications for TOE in suspected ?IE
Bacteraemia
IVDU
High risk cardiac condition
Indeterminate TTE
51
Indications for IE Prophylaxis
High risk heart condition - rheumatic, prosthetic valve
High risk surgery - dental, tonsillectomy, surgery at site of known infection
52
TB interferon test - how does it work?
Patient's plasma re-exposed to TB antigen - T cells will produce IFNy which can be detected
53
Uncomplicated P falciparum treatment
Simple - artemether + lumefantrine
Severe - significant organ involvement, parasite count > 100,000 or >10% - IV artesunuate
54
Treatment of P vivax/ovale
Add primaquine to standard treatment, beware G6PD deficienc
55
Malaria PPx
Doxycycline 1 day before and 4 weeks after
Malarone - Atuovacone + proguanil
56
C's of measles
Prodrome - fevrs, cough, coryzal, conjunctivitis
K(c)oplik's spots
Craniocaudal rash
57
Live vaccines
MMR BOY Japenese RITZ
BCG
Oral Polio
Yellow fever
Japanese encephalitis
Rotavirus
Typhoid
Zoster/Varicella
58
Chigger mites
Scrub typhus
59
Borelia burgfolderi
Lyme disease
60
Bullseye type rash which expands and grows bigger
Erythema migrans --> Lyme disease
61
Eating coral fish, paresthesias, temperature related dysethesias
Ciguatera
62
Vesicles at tip/side of nose
Hutchinson's sign
Concern for coreal involvement (Herpes zoster opthalmicus)
63
Acyclovir in VZV - benefits
Shortens duration of illness
If given < 48 hours, reduces severity of complications
64
Precautions for VZV
Chicken pox - negative pressure, till lesions have crusted
Shingles - uncomplicated, local dermatome --> standard precautions
65
Post-exposure PPx for VZV:
- Indication
- What to give
Indicated for those susceptible - no prior exposure, vaccination and undetectable Ig levels
If can have vaccine, give vaccine within 5 days
If cannot have vaccine, give VZV Ig within 10 days
66
Anaerobic cover options
Add metro
Augmentin
Penicillin hypersensitivity - clindamycin, moxifloxacin
67
Branching filamentous fungi with septate hyphae
Aspergillus
68
Tests for syphilis and diagnosis
Treponemal - qualitative
Non-treponemal (RPR) - measure titres.
Need both for diagnosis
69
HIV antimicrobial PPx
Bactrim for CD4 < 200 (for PJP)
No evidence for azithro for MAC < 50 anymore
70
Nocardia vs Actinomycoses
Snap
Sulfur Nocardia AFB aerobic filamentous gram positive rod
Actinomycoses penicillin anaerobic flimanetous gram positive rod
71
Factors affecting HIV progression
HIV-1 vs HIV-2 - HIV 1 more aggressive
Co-receptor - CXRC4 use more aggressive
CD38 on CD8 cells - more aggressive
72
Types of HIV testing
Screening
- Ab only - ELISA - false positives from window period
- Ab-Ag - AB and p24 antigen, can detect positive 10-14 days
Confirmatory
- 4th generation assay - HIV1 vs HIV2
- Western blot - IgG to HIV1. Takes long time
- HIV Viral RNA/load
73
HIV Rx A/E IHD
Abacavir
74
HIV Rx increased risk of rhabdo
Reltagravir
75
HIV Rx A/E elevated bilirubin
atazanavir
76
HIV Rx A/E renal colic
indanavir
77
Suffix of protease inhibitors in hiv
Joint A/E
-navir
Insulin resistance, hyperolipidaemia, lipodystrophy
78
Treatment of Hep B and HIV
TAF and emtricitabine
79
PrEP regimen
TAF and emtricitabine
80
CD4 < 50
MAC
CMV
81
CD4 < 200
PJP - give PPx
82
CD4 < 150
Cryptoccus
HSV
83
CD4 < 250
Oral candidiasis
84
Management of toxoplasmosis encephalitis
Pyrimethamine - antiparsitic DHFR antagonis
- give with folinic acid
AND
Sulfadiazine
85
Cell most implicated in sarcoid
TH1
- TNF, IFNy help with macrophage recruitment
- TNF inhibitors can be used for treatment
86
Activated or memory T cells cell surface marker
CD45Ro
87
Cells that produce IL-1?
Dendritic cells + macrophages
88
Inflammasome
- What is it
- Associated syndromes
- Treatment of syndromes
Cytoplasmic protein complex, which when assembly is triggered stimultes cytokine release (particularly IL-1)
Gout - NALP3
FMF - Pyrin inflammasome
Colchicine - inhibits microtubule formation (required for inflammasome formation)
Anakinra
89
T independant antigen for B cells
Lipopolysaccharides
- Can stimulate B directly
90
IFNy - deficiency causes infection with?
Mycobacterium
91
MSSA bacteraemia length of treatment
- Uncomplicated (no IE)
- IE
No IE - 2 weeks
IE - 4-6 weeks
92
UTI cause that is negative for nitrites?
Enterococcus faecalis
93
Candida - eye signs
Chorioretinitis
Endopthalmitis - inflammation within eye
94
PREP - monitoring?
STI testing 3 monthly
ACR and urine every 6 months (TAF)
95
Most sensitive and specific test for TB
TB MCS - sputum, fluid or tissue
80% sens, spec 98%
96
Most likely bug to cause nitrites on urine
E Coli
97
Asplenia - can you give yellow fever vaccine?
Yes
98
Azithromycin resistance due to?
Long half life
99
Neisseria meningitis
Previous severe hypersensitivity to penicillins?
Use?
Ciprofloxacin
100
Feature of Dengue that portends poor prognosis?
Increasing haemtaocrit
101
EBV antibody testing - excluded acute infection
EBNA Ig (nuclear antigen)
Only present after 6 weeks
102
Organism causing multiple, irregular, softer painful genital lesions
Hamophilus decrei
Chancroid
103
TSS-1 toxin
Toxic shocks syndrome
104
Young female
Fever
Hypotension
Erythematous rash tongue and hands and soles
TSS
105
Bug causing TSS
S aureus - strain that produces exotoxin
106
Rx of TSS
Vanc + fluclox to cover staph
Clinda for antitoxin cover
107
Forestry worker, tick bite
Ricksettia
108
Tick bite, fever, maculopapular rash, Australia
Ricksettia
109
Rx of ricksettia
Doxycycline
110
Panton Valentine Leucocidin (PVL)
-bug
-Most common infection
Staph aureus
Pyogenic skin infections
111
Rheumatic fever PPx
Benziathine pencillin every 21-28 days
Minimum for 5 years after diagnosis, or until age 21, whichever is longer
112
Hep C protease inhibitors
Have previr
113
Hep C NS5A inhibitors
- Role of NS5A
- Inhibitors have which suffix?
New protein and RNA processing and virion assembly
Suffix - asvir
114
Hep C NS5B inhibitors
- Role of NS5B
RNA dependant RNA polymerase --> replicate RNA for new viruses
Have B in them --> sofosbuvir
115
Two main pangenotypic Hep C regimens
SVE GPM
Sofosbuvir and vepravir = epclusa
Maviret = glcepravir and pibrentasvir
116
Sandfly
Chronic pink papule that evolves into plaque
Leishmeniasis
117
Alpha haemolytic strep
Strep pneumoniae
Viridans strep
118
Beta haemolytic strep
GAS - pyogenes
GBS - strep agalactiae
119
Gamma haemolytic strep
Enterococcus
120
IE association with CRC?
Strep gallolyticus
121
Strep Viridans
- Site
- Organisms
Ontongeic
Mutans, sanguinis, salivarus
122
Strep pyogenes
- antigen produced?
- toxin produced?
Streptolysin O - can induce molecular mimicry (rheumatic fever, post-strep GN). Can test ASOT titres
Exotoxin - TSS, pyogenic skin infection
123
Atypical cells on blood film in acute EBV
CD8
124
Two forms entamoeba
Cysts (ingested), infectious form
Trophozites - invade colon and blood stream
125
Treatment entamoeba
Intraluminal - paromycin
Invasive disease - metronidazole/tinidazole
126
Airborne precautions
- Requirements
- Indications
Negative pressure + respiratory
Indications
- TB
- Varicella
- Measles
- COVID
127
When should tetanus vaccine be given to someone previously vaccinated
Wound, >10 years since vaccine
128
When is tetanus IgG given
Major wound, no previous vaccine
129
Viral diarrhoea adults
Norovirus
130
Viral diarrhoea children
Rotavirus
131
Solid organ transplant
- Which organism for universal PPx?
Bactrim for PJP/PCP
132
Why add primaquine for ovax/vivale?
Eradicate dormant hyponizites
133
1st trimester pregnancy and malaria?
Use malarone
134
P falciparum with steady parasite count after 72 hours
Consiedr changing to:
- malarone
- quinine
Beware patients from mekong region
135
Cat bite
Gram negative coccobaccillus
Pasteurella
136
Most common method transmission Hep C
IVDU
137
MDR TB
RI and flouroquinolone + 1 other
138
Treatment for MDR TB
bPALM
Bedaquiline, pretomanid, linezolid, moxifloxacin
139
CI to sofosbuvir?
Renal impairment
140
Most important RF for acyclovir resistance
Immunosuppression
141
Most common valve for infective endocarditis
Mitral valve prolapse
142
Mutation in which receptor confers resistance to HIV infection
CCR5
x2 HSCT's where HIV was cured
143
Most common organism type to cause HAP
Aerobic gram negative bacilli - e.g Klebsiella
144
Strep pneumonia resistant to penicillin in meningitis - treat?
Vancomycin
145
MALDI-TOF
- Benefits
- Why MC&S is better
Rapid
Accurate identification of genus and species from wide range of bacteria
Will NOT grow rare bacteria, MC&S is more sensitive
146
Post rabies exposure with monkey bite 3 weeks ago. Normal rabies PEP vaccines are up to day 14.
Treatment?
Offer rabies vaccine
147
Treatment of stenotrophomonas
Bactrim
