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Year 3: Immunity; Infection > ID > Flashcards

ID Flashcards

1
Q
A
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2
Q

Most tropical infections becomes symptomatic within [] days of exposure

A

21 days

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3
Q
  • Fever AND travel to endemic area < 21 d - think ?
A
  • Fever AND travel to endemic area < 21 d - think Viral Haemorrhagic Fever
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4
Q

When diagnosing malaria - what investigation must you do? [1]

A

must be excluded using peripheral blood smear testing for
the malarial parasite

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5
Q

Bladder calcfication is associated with

Dengue
Rickettsia fevers
Malaria
Chikungunya
Leptospirosis
Schistosomiasis

A

Bladder calcfication is associated with

Dengue
Rickettsia fevers
Malaria
Chikungunya
Leptospirosis
Schistosomiasis

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6
Q

First line treatment for malaria? [1]

A

IV artesunate or quinine
if severe

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7
Q

Typhoid and paratyphoid are caused by [] and [] (types A, B & C) respectively

A

Typhoid and paratyphoid are caused by Salmonella typhi and Salmonella paratyphi (types A, B & C) respectively

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8
Q

Describe how typhoid/paratyphoid are transmitted [1]

Describe common features [6]

A

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

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9
Q

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?

A

Thyphoid - rose spots

present on the trunk in 40% of patients, and are more common in paratyphoid

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10
Q

If you suspect that someone has typhoid, where would there recent travel history be? [1]

A

Typical after SE Asia travel

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11
Q

Dengue fever is a viral infection that can progress to viral [] fever

A

Dengue fever is a viral infection that can progress to viral haemorrhagic fever

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12
Q

Dengue is transmitted by the [] mosquito

A

transmitted by the Aedes aegypti mosquito

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13
Q

Describe how patients with dengue fever can be classified [3]

A

dengue fever:
* without warning signs
* with warning signs

severe dengue (dengue haemorrhagic fever)

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14
Q

Describe the classic presentation of dengue fever [5]

A
  • 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
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15
Q

What are the warning signs of dengue fever? [4]

A

abdominal pain
hepatomegaly
persistent vomiting
clinical fluid accumulation (ascites, pleural effusion)

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16
Q

Describe what is meant by severe dengue (dengue haemorrhagic fever) [2]

What do 20-30% of patients develop after ^? [1]

A

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)

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17
Q

Describe what a chikungunya infection is like [1]

A

Tropical mosquito infection
Inc period 1-12 days

Causes severe arthralgia

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18
Q

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

A

swimmers’ itch

acute schistosomiasis syndrome (Katayama fever)
* fever
* urticaria/angioedema
* arthralgia/myalgia
* cough
* diarrhoea
* eosinophilia

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19
Q

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]

A

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

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20
Q

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]

A

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

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21
Q

How do you treat
Schistosoma haematobium? [1]

A

single oral dose of praziquantel

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22
Q

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]

A

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.

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23
Q

Rickettsia fevers occur via [] or [] bite.

A

flea or tick bite:
African tick typhus

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24
Q

Leptospirosis is caused by the spirochaete Leptospira interrogans (serogroup L. icterohaemorrhagiae), classically being spread by contact with []

A

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

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25
How do you detect Leptospira interrogans? [1]
1. **serology**: antibodies to Leptospira develop after about 7 days 2. PCR 3. 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
26
How do you manage Leptospira interrogans? [1]
high-dose **benzylpenicillin** or **doxycycline**
27
How does a patient with Leptospirosis present? [3]
**Jaundice, conjunctival suffusion, hepatorenal impairment**
28
**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 u**npasteurised milk and cheese** or from **contact with infected animals.** High areas of **farming** or **animal-human contact**
29
What are the typical features of Brucellosis infection? [3]
**Fever, weight loss, night sweats, lymphadenopathy** Important cause of PUO
30
What is the mangaement of brucellosis? [3]
**doxy, rifampicin, gent**
31
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
32
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.**
33
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)
34
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
35
Which organism causes ameobic liver abscesses? [1] How does it spread? [1]
**Entamoeba histolytica** via faecal-oral route
36
Entamoeba histolytica can manifest pathology in which two ways? [2]
**Amoebic dysentery** **Amoebic liver abscess**
37
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
38
How do you treat amoebic liver abscess? [2]
**Oral metronidazole + diloxanide furoate**
39
Recent visit to Eastern Europe/Russia/Asia would suggest infection of what cause? [1]
**Diphtheria**
40
41
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**
42
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 ## Footnote **Tropical mosquito infection Inc period 1-12 days**
43
How do you treat diptheria? [2]
**IM penicillin + diphtheria antitoxin**
44
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
45
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**
46
How do you treat Schistosoma haematobium? [1] Ciprofloxacin Doxycycline NSAIDs praziquantel Artesunate
How do you treat Schistosoma haematobium? [1] Ciprofloxacin Doxycycline NSAIDs **praziquantel** Artesunate
47
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
48
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
49
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
50
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
51
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
52
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**
53
Splenomegaly is most associated with Dengue Rickettsia fevers Malaria Chikungunya Leptospirosis Schistosomiasis
Splenomegaly is most associated with Dengue Rickettsia fevers **Malaria** Chikungunya Leptospirosis Schistosomiasis
54
**chloroquine**
55
every 48hrs
56
**most common type of non-falciparum malaria**
57
**toxoid**
58
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
59
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
60
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
61
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**
62
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**
63
The most common causes of viral meningitis in adults are **[]**
The most common causes of viral meningitis in adults are **enteroviruses** NOT Neisseria meningitidis
64
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**
65
Describe the following levels for bacterial, viral, fungal and TB caused meningitis 1. Appearance 2. Glucose 3. Protein 4. White cells
66
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.
67
Name a common treatment for bronchiectasis [1]
**Ciprofloxacin**
68
You suspect someone is suffering from infective mononucleosis. How would you confirm this? [1]
**The monospot test** - tests for EBV infectiom
69
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.
70
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
71
A patient has a reactivation of the HZV. How do you treat? [1]
**Intravenous Aciclovir**
72
Which of the following is the most hepatotoxic? Rifampicin Pyridoxine Ethambutol Pyrazinamide Isoniazid
**Pyrazinamide**
73
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
74
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
75
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**
76
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.
77
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.
78
Eating which food substances increases the liklihood of: - Hep A - Hep E
- Hep A: **shellfish** - Hep E: **pork**
79
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**
80
In a **pre-hospital setting**, suspected bacterial meningitis should be treated with []
**Intramuscular benzylpenicillin** - However, in hospital, intravenous antibiotics should be given.
81
Most likely cause of the 'common cold' is? [1]
**Rhinovirus**
82
The most common cause of croup is? [1]
**Parainfluenza virus**
83
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
84
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

Year 3: Immunity; Infection (16 decks)

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