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MRCP 1 > ID > Flashcards

ID Flashcards

1
Q

What are the two types of trypanosomiasis

A

African (sleeping sickness)
American (Chagas’)

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2
Q

Clinical features of African trypanosomiasis

A

Trypanosoma chancre - painless subcut nodule at site of infection
Intermittent fever
Enlargement of posterior cervical lymph nodes
Later - cns involvement - somnolence, headaches, mood changes, meningoencephalitis

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3
Q

Management of African trypanosomiasis

A

Early - IV pentamidine or suramin
Later (or cns involvement) - IV melarsoprol

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4
Q

Features of American trypanosomiasis

A

Asymptomatic in acute phase
Chagoma - erythematous nodule at site of infection
Myocarditis and arrhythmias later
GI features - megaoesophagus & megacolon causing dysphagia & constipation

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5
Q

Management of American trypanosomiasis

A

Most effective in acute phase - benznidazole or nifurtimox
Chronic management is managing complications eg hf

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6
Q

Most common non-falciparum malaria

A

Plasmodium vivax

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7
Q

Where are the non-falciparums from?

A

Vivax - Central America and Indian subcontinent
Ovale - Africa
Knowlesi- Southeast Asia

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8
Q

Features of the non-falciparums

A

General malaria - fever, headache, splenomegaly
Vivax/Ovale - cyclical fever every 48hrs
Malariae - cyclical fever every 72hr & associated with nephrotic syndrome

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9
Q

Treatment of the non-falciparums

A

ACT - avoid in pregnancy
Chloroquine- not if resistant area

Ovale or vivax should be given primaquine

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10
Q

Factors which reduce vertical transmission of HIV in pregnancy

A

Maternal antiretroviral therapy
Mode of delivery (caesarean)
Neonatal antiretroviral therapy
Infant feeding (bottle feeding)

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11
Q

Where is brucellosis common

A

Middle East and farmers, vets & abattoir workers

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12
Q

What are the four species that cause brucellosis

A

B melitensis (sheep)
B abortus (cattle)
B canis & B suis (pigs)

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13
Q

What is the brucellosis incubation period

A

2-6 weeks

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14
Q

Features of brucellosis

A

Fever, malaise
Hepatosplenomegaly
Sacroiliitis

Complications - osteomyelitis, infective endocarditis, meningoencephalitis, orchitis

Leukopenia often seen

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15
Q

Diagnosing brucellosis

A

Rose Bengal Plate test for screening
Brucella serology best option

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16
Q

Management of brucellosis

A

Doxy and streptomycin

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17
Q

Features of mycoplasma pneumoniae

A

Prolonged and gradual onset
Flu like symptoms before dry cough
Bilateral consolidation on cxr

18
Q

Complications of mycoplasma pneumonia

A

Cold agglutinatins (IgM) may cause an haemolytic anaemia, thrombocytopenia
Erythema multiforme, erythema nodosum
Meningoencephalitis, guillain barre
Bullous myringitis
Pericarditis/myocarditis
Hepatitis/pancreatitis
Acute glomerulonephritis

19
Q

Management of mycoplasma pneumonia

A

Doxy or a macrolide (erythromycin/clarithromycin)

20
Q

Aetiology of dengue fever

A

RNA virus
Transmitted by Aedes aegypti mosquito
Incubation 7 days

21
Q

Features of dengue fever

A

Fever
Headache (often retro-orbital)
Myalgia, bone pain, arthralgia
Pleuritic pain
Facial flushing
Maculopapular rash
Haemorrhagic manifestations - petechiae, pupura/ecchymosis, epistaxis
Warning signs - abdo pain, hepatomegaly, persistent vomiting, clinical fluid accumulation

22
Q

Features of severe dengue

A

Form of DIC - thrombocytopenia & spontaneous bleeding
Around 20-30% develop dengue shock syndrome

23
Q

Dengue investigations

A

Bloods - leukopenia, thrombocytopenia, raised aminoytansferases
Diagnostics - serology, NS1 antigen test, test for viral RNA

24
Q

Treatment of Dengue

A

Fluid resus
Blood transfusions

All symptomatic

25
Q

What causes Lyme disease

A

Borrelia burgdorferi
Spread by ticks

26
Q

Early features of Lyme disease

A

Erythema migrans - -
Bullseye rash at site of bite
Typically 1-4 week after bite
Painless bite

Systemic - headache, lethargy, fever, arthralgia

27
Q

Late features of Lyme disease

A

Heart block
Peri/myocarditis
Facial nerve palsy
Radicular pain
Meningitis

28
Q

Investigating Lyme disease

A

Clinically if can see erythema migrans
ELISA - look for antibodies to borrelia burgdorferi

29
Q

Management of Lymes

A

Doxy (not if pregnant)
Amox second line
Ceftriaxone if disseminated disease

30
Q

What’s the Jarisch-Herxheimer reaction

A

Acute febrile reaction that occurs within first 24hr of initiating treatment for spirochetal infections

Fever, chills, headache, myalgia and exacerbations of skin lesions

31
Q

How is Japanese encephalitis spread

A

Via culex mosquitos which breed in rice paddy fields
Common in south east Asia, China, India and the western pacific

32
Q

Clinical features of Japanese encephalitis

A

Mostly asymptomatic

Headache, fever, seizures and confusion
Parkinsonian features indicate basal ganglia involvement
Acute flaccid paralysis

33
Q

What is aspergilloma

A

A mycetoma (mass-like fungus ball) which often colonises and existing lung cavity (secondary to TB, lung cancer or cystic fibrosis)

34
Q

Features of aspergilloma

A

Asymptomatic
Cough
Haemoptysis

35
Q

Investigations of aspergilloma

A

Cxr - rounded opacity, crescent sign may be present
High titres aspergillus precipitins

36
Q

Where does one contract legionella

A

Colonises water tanks - air conditioning systems etc

37
Q

Legionella features

A

Flu-like symptoms
Dry cough
Relative bradycardia
Confusion
Lymphopenia
Hyponatremia
Deranged LFT’s
Pleural effusion - around 30% of patients

38
Q

Investigations for legionella

A

Urinary antigen
Cxr - non specific but may have mid to lower zone predominant patchy consolidation & pleural effusion

39
Q

Management of legionella

A

Erythromycin or clarithromycin

40
Q

Which vaccines are live

A

BCG
MMR
Influenza
Oral rotavirus
Ora polio
Yellow fever
Oral typhoid

MRCP 1 (14 decks)

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