ID Flashcards
Most tropical infections becomes symptomatic within [] days of exposure
21 days
- Fever AND travel to endemic area < 21 d - think ?
- Fever AND travel to endemic area < 21 d - think Viral Haemorrhagic Fever
When diagnosing malaria - what investigation must you do? [1]
must be excluded using peripheral blood smear testing for
the malarial parasite
Bladder calcfication is associated with
Dengue
Rickettsia fevers
Malaria
Chikungunya
Leptospirosis
Schistosomiasis
Bladder calcfication is associated with
Dengue
Rickettsia fevers
Malaria
Chikungunya
Leptospirosis
Schistosomiasis
First line treatment for malaria? [1]
IV artesunate or quinine
if severe
Typhoid and paratyphoid are caused by [] and [] (types A, B & C) respectively
Typhoid and paratyphoid are caused by Salmonella typhi and Salmonella paratyphi (types A, B & C) respectively
Describe how typhoid/paratyphoid are transmitted [1]
Describe common features [6]
typhoid is transmitted via the faecal-oral route (also in contaminated food and water)
Features:
* initially systemic upset
* relative bradycardia
* abdominal pain, distension
* constipation: although Salmonella is a recognised cause of diarrhoea, constipation is more common in typhoid
* rose spots: present on the trunk in 40% of patients, and are more common in paratyphoid
A patient presents with these spots on his chest.
He also complains of feeling unwell and abdominal pain. What is the most likely cause of infection?
Thyphoid - rose spots
present on the trunk in 40% of patients, and are more common in paratyphoid
If you suspect that someone has typhoid, where would there recent travel history be? [1]
Typical after SE Asia travel
Dengue fever is a viral infection that can progress to viral [] fever
Dengue fever is a viral infection that can progress to viral haemorrhagic fever
Dengue is transmitted by the [] mosquito
transmitted by the Aedes aegypti mosquito
Describe how patients with dengue fever can be classified [3]
dengue fever:
* without warning signs
* with warning signs
severe dengue (dengue haemorrhagic fever)
Describe the classic presentation of dengue fever [5]
- fever
- headache (often retro-orbital)
- myalgia, bone pain and arthralgia (‘break-bone fever’)
- pleuritic pain
- facial flushing (dengue)
- maculopapular rash
- haemorrhagic manifestations e.g. positive tourniquet test, petechiae, purpura/ecchymosis, epistaxis
What are the warning signs of dengue fever? [4]
abdominal pain
hepatomegaly
persistent vomiting
clinical fluid accumulation (ascites, pleural effusion)
Describe what is meant by severe dengue (dengue haemorrhagic fever) [2]
What do 20-30% of patients develop after ^? [1]
this is a form of disseminated intravascular coagulation (DIC) resulting in:
* thrombocytopenia
* spontaneous bleeding
* around 20-30% of these patients go on to develop dengue shock syndrome (DSS)
Describe what a chikungunya infection is like [1]
Tropical mosquito infection
Inc period 1-12 days
Causes severe arthralgia
Schistosomiasis, or bilharzia, is a parasitic flatworm infection. The three main species of schistosome are S. mansoni, S. japonicum and S. haematobium.
Describe the acute manifestations of infection
swimmers’ itch
acute schistosomiasis syndrome (Katayama fever)
* fever
* urticaria/angioedema
* arthralgia/myalgia
* cough
* diarrhoea
* eosinophilia
Schistosomiasis, or bilharzia, is a parasitic flatworm infection. The three main species of schistosome are S. mansoni, S. japonicum and S. haematobium.
Describe how a chronic infection of Schistosoma haematobium would present (hint - where do the eggs lay?) [3]
These worms deposit egg clusters (pseudopapillomas) in the bladder, causing inflammation.
The calcification seen on x-ray is actually calcification of the egg clusters, not the bladder itself.
Can cause an obstructive uropathy and kidney damage typically presents as a’swimmer’s itch’ in patients who have recently returned from Africa:
* frequency
* haematuria
* bladder calcification
Schistosomiasis, or bilharzia, is a parasitic flatworm infection. The three main species of schistosome are S. mansoni, S. japonicum and S. haematobium.
Describe you investigate a chronic infection of Schistosoma haematobium?
- for asymptomatic and symptomatic patients [2]
Investigation
for asymptomatic”
- patients serum schistosome antibodies are generally preferred
symptomatic patients:
- the gold standard for diagnosis is urine or stool microscopy looking for eggs
How do you treat
Schistosoma haematobium? [1]
single oral dose of praziquantel
Schistosomiasis, or bilharzia, is a parasitic flatworm infection. The three main species of schistosome are S. mansoni, S. japonicum and S. haematobium
Where do these effect? [2]
How can this present? [1]
These worms mature in the liver and then travel through the portal system to inhabit the distal colon
Their presence in the portal system can lead to progressive hepatomegaly and splenomegaly due to portal vein congestion.
Rickettsia fevers occur via [] or [] bite.
flea or tick bite:
African tick typhus
Leptospirosis is caused by the spirochaete Leptospira interrogans (serogroup L. icterohaemorrhagiae), classically being spread by contact with []
Leptospirosis is caused by the spirochaete Leptospira interrogans (serogroup L. icterohaemorrhagiae), classically being spread by contact with infected rat urine.
* leptospirosis is commonly seen in questions referring to sewage workers, farmers, vets or people who work in an abattoir
* however, on an international level, leptospirosis is far more common in the tropics so should be considered in the returning traveller
How do you detect Leptospira interrogans? [1]
- serology: antibodies to Leptospira develop after about 7 days
- PCR
- culture
* growth may take several weeks so limits usefulness in diagnosis
* blood and CSF samples are generally positive for the first 10 days
* urine cultures become positive during the second week of illness
How do you manage Leptospira interrogans? [1]
high-dose benzylpenicillin or doxycycline
How does a patient with Leptospirosis present? [3]
Jaundice, conjunctival suffusion,
hepatorenal impairment
Brucellosis is an infection you can catch from [] or [].
If a patient has a fever and presents from an area of [], think brucellosis [1]
Brucellosis is an infection you can catch from unpasteurised milk and cheese or from contact with infected animals.
High areas of farming
or animal-human contact
What are the typical features of Brucellosis infection? [3]
Fever, weight loss, night sweats,
lymphadenopathy
Important cause of PUO
What is the mangaement of brucellosis? [3]
doxy, rifampicin,
gent
What medication do you give to treat typhoid?
Ciprofloxacin
Doxycycline
NSAIDs
praziquantel
Artesunate
What medication do you give to treat typhoid?
Ciprofloxacin
Doxycycline
NSAIDs
praziquantel
Artesunate
Tetanus is caused by the tetanospasmin exotoxin released from []
Tetanus spores are present in soil and may be introduced into the body from a wound, which is often unnoticed.
Tetanospasmin prevents the release of []
In developed countries, tetanus may be seen in which population? [1]
Tetanus is caused by the tetanospasmin exotoxin released from Clostridium tetani.
Tetanus spores are present in soil and may be introduced into the body from a wound, which is often unnoticed.
Tetanospasmin prevents the release of GABA,
In developed countries, tetanus may be seen in intravenous drug users.
What are the features of tetanus infection? [4]
- prodrome fever, lethargy, headache
- trismus (lockjaw)
- risus sardonicus: facial spasms
- opisthotonus (arched back, hyperextended neck)
- spasms (e.g. dysphagia)
How do you treat tetanus? [4]
- supportive therapy including ventilatory support and muscle relaxants
- intramuscular human tetanus immunoglobulin for high-risk wounds (e.g. compound fractures, delayed surgical intervention, significant degree of devitalised tissue)
- metronidazole is now preferred to benzylpenicillin as the antibiotic of choice
Which organism causes ameobic liver abscesses? [1]
How does it spread? [1]
Entamoeba histolytica via faecal-oral route
Entamoeba histolytica can manifest pathology in which two ways? [2]
Amoebic dysentery
Amoebic liver abscess
Entamoeba histolytica can cause amoebic dysentery and amoebic liver abscess.
Describe how each present [2]
Amoebic dysentery
* profuse, bloody diarrhoea
there may be a long incubation period
* stool microscopy may show trophozoites if examined within 15 minutes or kept warm (known as a ‘hot stool’)
Amoebic liver abscess
* usually a single mass in the right lobe (may be multiple). The contents are often described as ‘anchovy sauce’
* fever
* right upper quadrant pain
* systemic symptoms e.g. malaise
* hepatomegaly
How do you treat amoebic liver abscess? [2]
Oral metronidazole +
diloxanide furoate
Recent visit to Eastern
Europe/Russia/Asia would suggest infection of what cause? [1]
Diphtheria
Describe typical presentation of Diphtheria
- Diphtheria toxin commonly causes a ‘diphtheric membrane’ on tonsils caused by necrotic mucosal cells. Systemic distribution may produce necrosis of myocardial, neural and renal tissue
- bulky cervical lymphadenopathy - may result in a ‘bull neck’ appearanace
- neuritis e.g. cranial nerves
- heart block
A patient presents with severe arthalgia
What is the most likely diagnosis?
Dengue
Rickettsia fevers
Chikungunya
Malaria
Leptospirosis
Schistosomiasis
A patient presents with severe arthalgia
What is the most likely diagnosis?
Dengue
Rickettsia fevers
Chikungunya
Malaria
Leptospirosis
Schistosomiasis
Tropical mosquito infection
Inc period 1-12 days
How do you treat diptheria? [2]
IM penicillin +
diphtheria antitoxin
What medication do you give to treat dengue?
Ciprofloxacin
Doxycycline
NSAIDs
praziquantel
Artesunate
What medication do you give to treat dengue?
Ciprofloxacin
Doxycycline
NSAIDs
praziquantel
Artesunate
Which infectious organism is most likely to cause increase in eosinophils?
Dengue
Rickettsia fevers
Malaria
Chikungunya
Leptospirosis
Schistosomiasis
Which infectious organism is most likely to cause increase in eosinophils?
Dengue
Rickettsia fevers
Malaria
Chikungunya
Leptospirosis
Schistosomiasis
How do you treat
Schistosoma haematobium? [1]
Ciprofloxacin
Doxycycline
NSAIDs
praziquantel
Artesunate
How do you treat
Schistosoma haematobium? [1]
Ciprofloxacin
Doxycycline
NSAIDs
praziquantel
Artesunate
A patient is infected with African tick typhus
What is the most likely diagnosis?
Dengue
Rickettsia fevers
Chikungunya
Malaria
Leptospirosis
Schistosomiasis
A patient is infected with African tick typhus
What is the most likely diagnosis?
Dengue
Rickettsia fevers
Chikungunya
Malaria
Leptospirosis
Schistosomiasis
A patient presents with Fever, sweating, headache,
vomiting, pallor, jaundice, hepatosplenomegaly.
What is the most likely diagnosis?
Dengue
Rickettsia fevers
Malaria
Chikungunya
Leptospirosis
Schistosomiasis
A patient presents with Fever, sweating, headache,
vomiting, pallor, jaundice, hepatosplenomegaly.
What is the most likely diagnosis?
Dengue
Rickettsia fevers
Malaria
Chikungunya
Leptospirosis
Schistosomiasis
A patient has been rafting in fresh water
What is the most likely diagnosis?
Dengue
Rickettsia fevers
Malaria
Chikungunya
Leptospirosis
Schistosomiasis
A patient has been rafting in fresh water
What is the most likely diagnosis?
Dengue
Rickettsia fevers
Malaria
Chikungunya
Leptospirosis
Schistosomiasis
A patient has recently been to Zambia and been on safari.
What is the most likely diagnosis for their fever
Dengue
Rickettsia fevers
Malaria
Chikungunya
Leptospirosis
Schistosomiasis
A patient has recently been to Zambia and been on safari.
What is the most likely diagnosis for their fever
Dengue
Rickettsia fevers
Malaria
Chikungunya
Leptospirosis
Schistosomiasis
A patient has recently been on holiday to Africa.
They show you a bite they have on their leg.
What is the most likely diagnosis for their fever
Dengue
Rickettsia fevers
Malaria
Chikungunya
Leptospirosis
Schistosomiasis
A patient has recently been on holiday to Africa.
They show you a bite they have on their leg.
What is the most likely diagnosis for their fever
Dengue
Rickettsia fevers
Malaria
Chikungunya
Leptospirosis
Schistosomiasis
Shows Eschar
A patient has recently been on holiday to Africa.
They show have an extreme itch and also a rash which is shown below.
What is the most likely diagnosis for their fever
Dengue
Rickettsia fevers
Malaria
Chikungunya
Leptospirosis
Schistosomiasis
A patient has recently been on holiday to Africa.
They show have an extreme itch and also a rash which is shown below.
What is the most likely diagnosis for their fever
Dengue
Rickettsia fevers
Malaria
Chikungunya
Leptospirosis
Schistosomiasis
Splenomegaly is most associated with
Dengue
Rickettsia fevers
Malaria
Chikungunya
Leptospirosis
Schistosomiasis
Splenomegaly is most associated with
Dengue
Rickettsia fevers
Malaria
Chikungunya
Leptospirosis
Schistosomiasis
chloroquine
every 48hrs
most common type of non-falciparum malaria
toxoid
A 20-year-old female who recently visited the jungles of Peru for 7 days presents to your clinic. She became ill on the 5th day of her trip with fever, diffuse pain in her legs and lethargy. A few days later she felt much better, however, as of today she deteriorated with visible jaundice, high fever and multiple episodes of vomiting. On examination, there are no obvious skin changes other than jaundice.
What is the most likely diagnosis?
Malaria
Dengue fever
Leptospirosis
Yellow fever
Hepatitis B
Yellow fever
- Classically it will present in two phases where the patient experiences a brief remission in between.
- may cause mild flu-like illness lasting less than one week
classic description involves sudden onset of high fever, rigors, nausea & vomiting. Bradycardia may develop. A brief remission is followed by jaundice, haematemesis, oliguria
if severe jaundice, haematemesis may occur
Councilman bodies (inclusion bodies) may be seen in the hepatocytes
How do you treat a patient with ? tetanus and a uncertain tetanus vaccination history [1]
Patients with an uncertain tetanus vaccination history should be given a booster vaccine + immunoglobulin, unless the wound is very minor and < 6 hours old
How do you treat a patient with ? tetanus if they’ve had a full course of tetanus vaccines, with the last dose < 10 years ago?
no vaccine nor tetanus immunoglobulin is required, regardless of the wound severity
How do you treat a patient with ? tetanus if they’ve had a full course of tetanus vaccines, with the last dose > 10 years ago
- AND the wound is tetanous prone [1]
- OR it’s a high risk wound (e.g. compound fracture / significant degree of divialised tissue)
Patient has had a full course of tetanus vaccines, with the last dose > 10 years ago
if tetanus prone wound: reinforcing dose of vaccine
high-risk wounds (e.g. compound fractures, delayed surgical intervention, significant degree of devitalised tissue): reinforcing dose of vaccine + tetanus immunoglobulin
First line treatment for early Lyme disease is a 14-21 day course of oral []
First line treatment for early Lyme disease is a 14-21 day course of oral doxycycline
The most common causes of viral meningitis in adults are []
The most common causes of viral meningitis in adults are enteroviruses
NOT Neisseria meningitidis
A patient presents with Normocytic anaemia, thrombocytopaenia and AKI following diarrhoeal illness.
You think she might have HUS.
What is the most common cause of HUS in the developed world? [1]
E. coli
Describe the following levels for bacterial, viral, fungal and TB caused meningitis
- Appearance
- Glucose
- Protein
- White cells
Describe three complications of rheumatic fever [3]
Recurrent Tonsillitis:
- This is the most common complication. The evidence base for tonsillectomies as a treatment is poor, leading to stricter referral criteria.
Retropharyngeal Abscess
- A rare complication characterized by soft tissue swelling, more common in young children. Symptoms include a stiff and extended neck and refusal to eat or drink.
Peritonsillar Abscess (Quinsy):
- Presents with sore throat, difficulty swallowing, peritonsillar bulge, uvular deviation, trismus, and muffled voice. Treatment has shifted from surgical drainage to antibiotics and aspiration.
Lemierre’s Syndrome:
- In this rare complication, inflammation leads to pharyngotonsilitis, inflammation within the internal jugular vein, and septic emboli. Treatment may require high-dose benzylpenicillin and debridement.
Name a common treatment for bronchiectasis [1]
Ciprofloxacin
You suspect someone is suffering from infective mononucleosis.
How would you confirm this? [1]
The monospot test - tests for EBV infectiom
A patient becomes ill after eating undercooked poultry. What is the most likely cause? [1]
C jejuni is a common cause of gastroenteritis, with transmission classically resulting from ingesting undercooked or contaminated poultry. C. jejuni typically presents with diarrhoea, which may be bloody, and rarely with vomiting.
A patient suffers from influeza & heart failure. How do you treat? [1]
Oral Oseltamivir
It has been shown that patients with severe co-morbidities such as heart failure should receive antivirals to reduce the effects of a severe infection and further complications. The main types used are neuraminidase inhibitors
A patient has a reactivation of the HZV. How do you treat? [1]
Intravenous Aciclovir
Which of the following is the most hepatotoxic?
Rifampicin
Pyridoxine
Ethambutol
Pyrazinamide
Isoniazid
Pyrazinamide
Which of the following is the most may result in the failure of the oral contraceptive pill?
Rifampicin
Pyridoxine
Ethambutol
Pyrazinamide
Isoniazid
Which of the following is the most may result in the failure of the oral contraceptive pill?
Rifampicin
Pyridoxine
Ethambutol
Pyrazinamide
Isoniazid
Which of the following is associated with arthralgia??
Rifampicin
Pyridoxine
Ethambutol
Pyrazinamide
Isoniazid
Which of the following is associated with arthralgia??
Rifampicin
Pyridoxine
Ethambutol
Pyrazinamide
Isoniazid
What centor score do you give medication? [1]
What do you give? [1]
3 or 4 requires treatment as it indicates Group A streptococcal pharyngitis
Give oral phenoxymethylpenicillin
A 75-year-old female presents to the emergency department with a cough and shortness of breath, which has worsened over the last week. She has a past medical history of hypertension and has recently had a viral “chest infection.” On examination, she is pyrexial, and a chest x-ray shows a cavitating lung lesion in the right lower zone.
What is the most likely causative organism?
Staphylococcus aureus tends to follow viral pneumonia. The young and the old are at increased risk compared to the rest of the population.
a patient suffering from a pseudomonas urinary infection should be treated with which drug? [1]
Gentamicin
Aminoglycosides are the agents of choice for pseudomonal urinary tract infections.
Eating which food substances increases the liklihood of:
- Hep A
- Hep E
- Hep A: shellfish
- Hep E: pork
In a hospital setting, suspected bacterial meningitis should be treated with IV [] (or []) for adults < 50 years
In a hospital setting, suspected bacterial meningitis should be treated with IV [] and [] for adults > 50 years
In a hospital setting, suspected bacterial meningitis should be treated with IV cefotaxime (or ceftriaxone) for adults < 50 years
In a hospital setting, suspected bacterial meningitis should be treated with Intravenous cefotaxime and amoxicillin > 50 years
In a pre-hospital setting, suspected bacterial meningitis should be treated with []
Intramuscular benzylpenicillin
- However, in hospital, intravenous antibiotics should be given.
Most likely cause of the ‘common cold’ is? [1]
Rhinovirus
The most common cause of croup is? [1]
Parainfluenza virus
Immunocompromised patients with toxoplasmosis are treated with
Co-trimoxazole and prednisolone
Fluconazole
Pyrimethamine and sulphadiazine
Amphotericin B
Pentamidine and prednisolone
Immunocompromised patients with toxoplasmosis are treated with
Co-trimoxazole and prednisolone
Fluconazole
Pyrimethamine and sulphadiazine
Amphotericin B
Pentamidine and prednisolone
What are the incubation for common infections?
< 1 week:
1–2 weeks:
2–3 weeks:
>3 weeks:
< 1 week: Meningococcus, Diphtheria, influenza, coronavirus, scarlet fever
1–2 weeks: malaria, dengue fever, typhoid, measles
2–3 weeks: mumps, rubella, chickenpox
> 3 weeks: infectious mononucleosis, cytomegalovirus (CMV), viral hepatitis, HIV
