ID

Question 1

What are the two types of trypanosomiasis

Answer 1

African (sleeping sickness)
American (Chagas’)

Question 2

Clinical features of African trypanosomiasis

Answer 2

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

Question 3

Management of African trypanosomiasis

Answer 3

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

Question 4

Features of American trypanosomiasis

Answer 4

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

Question 5

Management of American trypanosomiasis

Answer 5

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

Question 6

Most common non-falciparum malaria

Answer 6

Plasmodium vivax

Question 7

Where are the non-falciparums from?

Answer 7

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

Question 8

Features of the non-falciparums

Answer 8

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

Question 9

Treatment of the non-falciparums

Answer 9

ACT - avoid in pregnancy
Chloroquine- not if resistant area

Ovale or vivax should be given primaquine

Question 10

Factors which reduce vertical transmission of HIV in pregnancy

Answer 10

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

Question 11

Where is brucellosis common

Answer 11

Middle East and farmers, vets & abattoir workers

Question 12

What are the four species that cause brucellosis

Answer 12

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

Question 13

What is the brucellosis incubation period

Answer 13

2-6 weeks

Question 14

Features of brucellosis

Answer 14

Fever, malaise
Hepatosplenomegaly
Sacroiliitis

Complications - osteomyelitis, infective endocarditis, meningoencephalitis, orchitis

Leukopenia often seen

Question 15

Diagnosing brucellosis

Answer 15

Rose Bengal Plate test for screening
Brucella serology best option

Question 16

Management of brucellosis

Answer 16

Doxy and streptomycin

Question 17

Features of mycoplasma pneumoniae

Answer 17

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

Question 18

Complications of mycoplasma pneumonia

Answer 18

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

Question 19

Management of mycoplasma pneumonia

Answer 19

Doxy or a macrolide (erythromycin/clarithromycin)

Question 20

Aetiology of dengue fever

Answer 20

RNA virus
Transmitted by Aedes aegypti mosquito
Incubation 7 days

Question 21

Features of dengue fever

Answer 21

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

Question 22

Features of severe dengue

Answer 22

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

Question 23

Dengue investigations

Answer 23

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

Question 24

Treatment of Dengue

Answer 24

Fluid resus
Blood transfusions

All symptomatic

Question 25

What causes Lyme disease

Answer 25

Borrelia burgdorferi Spread by ticks

Question 26

Early features of Lyme disease

Answer 26

Erythema migrans - - Bullseye rash at site of bite Typically 1-4 week after bite Painless bite Systemic - headache, lethargy, fever, arthralgia

Question 27

Late features of Lyme disease

Answer 27

Heart block Peri/myocarditis Facial nerve palsy Radicular pain Meningitis

Question 28

Investigating Lyme disease

Answer 28

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

Question 29

Management of Lymes

Answer 29

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

Question 30

What’s the Jarisch-Herxheimer reaction

Answer 30

Acute febrile reaction that occurs within first 24hr of initiating treatment for spirochetal infections Fever, chills, headache, myalgia and exacerbations of skin lesions

Question 31

How is Japanese encephalitis spread

Answer 31

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

Question 32

Clinical features of Japanese encephalitis

Answer 32

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

Question 33

What is aspergilloma

Answer 33

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

Question 34

Features of aspergilloma

Answer 34

Asymptomatic Cough Haemoptysis

Question 35

Investigations of aspergilloma

Answer 35

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

Question 36

Where does one contract legionella

Answer 36

Colonises water tanks - air conditioning systems etc

Question 37

Legionella features

Answer 37

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

Question 38

Investigations for legionella

Answer 38

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

Question 39

Management of legionella

Answer 39

Erythromycin or clarithromycin

Question 40

Which vaccines are live

Answer 40

BCG MMR Influenza Oral rotavirus Ora polio Yellow fever Oral typhoid