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MRCP - Part 1 > ID > Flashcards

ID Flashcards

1
Q

What is an effective way of reducing transmission of HIV from mother to baby when pregnant?

A

Postnatal administration of zidovudine to the baby

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2
Q

What is the most common bacterial infection of industrialised countries?

A

Campylobacter enteritis

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3
Q

What meat often gives campylobacter infection?

A

Chicken

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4
Q

What does the parasite entameoba histolytica cause

A

Intestinal sx (usually bloody diarrhoea)
extra intestinal manifestations (usually liver abscess)

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5
Q

Treatment of tapeworm

A

Niclosamide

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6
Q

What causes cholera

A

Vibrio cholerae

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7
Q

Presentation of cholera

A

Abrupt onset of voluminous watery diarrhoea
Hypoglycaemia
No blood in stool

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8
Q

Treatment of cholera

A

Rehydration
Doxycycline or co-trimoxazole

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9
Q

What foodstuffs can you get cholera

A

Shellfish

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10
Q

Presentation of salmonella enteritiis

A

Significant abdo pain
Blood and mucus in stool

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11
Q

Test for lymes disease

A

ELISA test

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12
Q

causative organism of lymes disease

A

Borrelia Burgdorferi

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13
Q

Which hepatitis virus relies on conceurrent hep B infection for replication?

A

Hep D

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14
Q

WHat does a positive HAV-IgM and positive HAV-IgG mean?

A

Acute hep A is likely

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15
Q

What does a positive HAV-IgG and negative HAV-IgM indicate?

A

Past Hep A or immunity from previous vaccination

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16
Q

WHat serological test rises in current Hep B infection?

A

HbsAg (surface antigen)

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17
Q

WHat indicates the progression to chronic hep B (serologically)

A

HBsAg, HBeAg, HBVDNA

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18
Q

What indicated Hep B infection in the last 6 months

A

IgM anti-HBc

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19
Q

What does IgG anti-Hbc indicate?

A

persists for life and indicates past infection

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20
Q

what does anti-HBs without anti-HBC indicate?

A

Immunisation

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21
Q

What serological test confirms exposure of Hep C

A

anti-HCV antibodies

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22
Q

What serological test confirms ongoing Hep C infection

A

HCV-PCR

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23
Q

WHat is granuloma inguinae and how does it present

A

Caused by Klebsiella granulomatis
Reproduces in neutrophils plasma cells and histocytes
Primary painless indurated nodule
Progresses to a healed up ulcer

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24
Q

WHat does granuloma inguinae contain

A

Donovan bodies

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25
Q

Treatment of granuloma inguinae

A

Doxycycline or co-trim

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26
Q

Serology of aspergillosis

A

Aspergillus RAST
IgE
Beta glucan
Galactomannan

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27
Q

What is on a CXR when you have histoplasmosis?

A

Diffuse reinonodular changes (no change in 40-50%)

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28
Q

Treatment of cryptococcal meningitis

A

Amphotericin B

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29
Q

investigation for gonnorhoea in women

A

Endocervical swabs and NAAT

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30
Q

Quinine in malaria and insulin

A

Quinine stimulates insulin release due to extreme catabolism of the burden of malaria infection
These two factors together when given IV quinine can cause severe hypoglycaemia

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31
Q

Treatment of toxoplasmosis in immunocompromised individuals

A

pyrimethamine with sulfadiazine and folinic acid

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32
Q

Presentation of leprosy

A

Nodular rash
Gradual scarring of peripheral nerves results in sensory loss

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33
Q

Initial treatment of leprosy

A

Rifampicin, dapsone and clodazimine

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34
Q

Skin biopsy of nodules in leprosy shows what?

A

AFB (acid fast bacilli)

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35
Q

What is the hallmark sign of systemic meningococcal disease?

A

haemorrhagic skin lesions

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36
Q

Features of plasmodium vivax and plasmodium ovale compared to other species of malaria

A

Have an additional life cycle stage during which hypnozoites form in the liver
Can reactivate months to years after infection

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37
Q

Treatment of plasmodium vivax and ovale

A

Artemther-lumefantrine or chloroquine
then
Primaquine (eradicates hypnozoite stage of disease)

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38
Q

Presentation of measles

A

Koplicks spots
Fever
Malaise
Conjunctivitis
Cough
Coryzal sx
Then maculopapular rash develops
spreading from behind ears to face and migrates caudally
Lymphadenopathy and high fever
Cough up to 3 weeks

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39
Q

What can indicate PCP / pneumocistis jiroverci

A

Elevated 1,3 beta-D glucan levels

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40
Q

What is potts disease

A

Those with TB
Spondyolitis (especially of lower thoracic spine)
Paraspinous TB abscesses
Psoas abscess
Cord compression
Marked acute phase response with lymphocytosis

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41
Q

How long is reommended treatment for patients with TB treatment to the bone

A

12 months

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42
Q

How long does mycobacterium tuberculosis take to multiply

A

18-24 hours
much slower than other organisms

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43
Q

What does bone marrow biopsy showed Hodgkins lymphoma

A

Reed Sternberg cells

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44
Q

What usually preceeds the rash in measles

A

Flu like symptoms
Conjunctivitis

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45
Q

How does NAC work in paracetomal overdose?

A

Conjugation with the toxic metabolite as an exogenous gluthione source

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46
Q

What is whipples disease

A

A rare chronic multisystem condition caused by the combination of
- infection with gram positive actinobacteria (tropheryma whipellei)
- abnormal response of cell mediated immunity

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47
Q

Presentation of whipples disease

A

GI Sx
- abdo pain
- diarrhoea
- abdo distension
- steatorrhoea
- anorexia
Lymphadenopathy
Arthropathy
Cough
Intermittent pyrexia
As condition progresses; may be
- cardiac, neurological or resp involvement

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48
Q

Treatment of whipples

A

Long term Abx therapy (1-2 years)
e.g. 14 days ceftriaxone or benpen
followed by a years maintenance therapy of TMP

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49
Q

Risk factors for whipples disease

A

Working in agricultural environment
Sewage plant workers

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50
Q

Diagnosis of whipples disease

A

Jejunal biopsy
- deposition of macrophages containing PAS-positive granules within the villi

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51
Q

What is visceral leishmaniasis caused by

A

protozoa of Leishmana species
Vectored by the sand fly

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52
Q

Presentation of visceral leishmaniasis

A

Prolonged chronic deterioration
fevers
night sweats
epistaxis
dry cough
proceeding to weight loss, and further decline
Hepatosplenomegaly
Lymphadenopathy

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53
Q

Diagnosis of visceral leishmaniasis

A

Microscopy and culture
- of either a lymph node aspirate, splenic biopsy or bone marrow aspirate

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54
Q

Skin manifestations of typhoid

A

Maculopapular rose spots which blanch on pressing

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55
Q

Presentation of typhoid

A

Diarrhoea or constipation at onset
Fever
Malaise
Headache
Cough
Anorexia
Maculopapular rose spots

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56
Q

Blood findings of typhoid

A

Raised transaminases
Neutropenia

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57
Q

Causative organism of typhoid

A

Salmonella typhi

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58
Q

Treatment of PJP

A

Co-trimoxazole

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59
Q

Presentation of leptospirosis

A

Fever
Maliase
Conjunctiviits
Flu like symptoms
Progresses to
- jaundice
- hepatomegaly
- AKI
- aseptic meningitis (Weils disease)

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60
Q

Treatment of leptospirosis

A

IV penicillin

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61
Q

Where do you commonly catch brucellosis

A

Middle east

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62
Q

Who is at risk of leptospirosis

A

Infected animal urine (usually rats) / contaminated water
Contact with animals
Sewage workers
Farmers
Canoeists/rowers

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63
Q

Treatment of strongylodiasis infection

A

Albendazole for 3 days, can be repeated after 3 weeks if required
Ivermectin

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64
Q

Treatment of giardiasis

A

Tinidazole

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65
Q

What is strongylodiasis

A

Parasitic roundworm

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66
Q

How is strongylodiasis caught

A

Contact between bare skin and soil

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67
Q

Presentation of strongylodiasis

A

Can be asymptomatic
Abdo pain
Intermittent diarrhoea
Malabsorption
Weight loss
Loffler syndrome - pneumonitis if the larve migrate to the lungs

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68
Q

What does strongylodiasis cause on blood tests

A

Marked eosinophilia

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69
Q

Which serological marker shows vaccination success after Hep B immunisation

A

Anti-HBs antibodies

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70
Q

Diarrhoea of cholera is often described as what

A

Rice water stools

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71
Q

What is rocky mountain spotted fever and where is it seen

A

USA and south america
Caused by Rickettsia rickettsii, spread by ticks

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72
Q

Presentation of rocky mountain spotted fever

A

Non generalised headaches
Fever
Distinctive erythematous macular rash on palms and soles that moves centripetaly and after days may become petechial

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73
Q

Treatment of rocky moutnain spotted fever

A

Doxycycline
If pregnant - chloramphenicol

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74
Q

What should all individuals be screened for before treatment with primaquine

A

G6PD

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75
Q

Which type of malaria causes the most severe form of the disease

A

Plasmodium falciparum

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76
Q

Diagnostic tests of malaria

A

Serial thick and thin malaria blood films

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77
Q

Treatment of uncomplicated falciiparum malaria

A

Artemesinin combination therapy for at least 3 days

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78
Q

Treatment of severe falciuparum malaria

A

IV artesunate
2nd line - 5 day course IV quinine followed by second agent (e.g. doxy) for 7 days

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79
Q

What is regarded as a positive mantoux test

A

> 5mm regardless of previous BCG

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80
Q

What HPV viruses are most assosiated with cervical cancers

A

HPV-16 and HPV-18

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81
Q

WHat is thrichomonas vaginalis

A

Sexually transmitted protozoal infection

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82
Q

Presentation of thrichomonas vaginalis

A

Frothy vaginal discharge
Strawberry cervix O/E

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83
Q

Treatment of trichomonas vaginals

A

Metronidazole

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84
Q

What is an argyll robertson pupil and where is this seen as a complication of

A

Accomodates but does not react
Tertirary syphillis

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85
Q

Stool specimen analysis in cholera

A

Comma-shaped gram negative bacilli

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86
Q

What skin manifestation is assosiated with mycoplasma pneumonia

A

Erythema multiforme

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87
Q

How is dengue fever transmitted

A

Female mosquitos
- Aedes ageypti
- adedes albopictus

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88
Q

Presentation of dengue fever

A

Fever
Headache
Pain behind the eyes
Muscle and joint pains
Nausea and vomiting
Swollen glands
Rash

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89
Q

Diagnosis of dengue fever

A

Serum RT-PCR
Serum NS1
Serum ELISA

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90
Q

What is seen on ELISA test in dengue fever

A

IgM detectable after 1 week up until 12 weeks
IgG indicative of past infection and can remain in blood for many years

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91
Q

Treatment of dengue fever

A

Symptomatic

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92
Q

What is hydatid disease

A

Caused by dog tapeworm Echinococcus granulosis
Immediate host agricultural animal e.g. sheep

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93
Q

Presentation of hydatid disease

A

Cysts form in liver and lungs - leading to compesssive symptoms (slow growing)
- haemoptysis
- abdominal pain
- hepatomegaly

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94
Q

WHat is toxic shock syndrome

A

Acute, severe, multisystem inflammatory response secondary to streptococcal and staphylococcal bacterial toxin release

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95
Q

Most common causes of toxic shock syndrome

A

Staph A
Strep pyogenes

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96
Q

Presentation of toxic shock syndrome

A

Viral type symptoms
Pyreixa
Shock (hypotension)
Rash with potential future desquamation
Circulatory collapse
Potential for organ failure

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97
Q

Common antibiotic regime of TSS

A

IV clinda + IV fluclox/vancomycin

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98
Q

Most common cayses of necrotising fascitis

A
  1. Strep pyogenes (group A)
  2. Klebsiella, Clostridium, E coli, Staph A
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99
Q

Chalymydia and staining

A

Chalymudia organisms too small to see on staining - cannot grow on any free media

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100
Q

Common cause of keratitis with dendritic ulceration of the cornea

A

HSV

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101
Q

Presentation of HSV keratitis

A

Acute onset of pain
Blurred vision
Conjunctival injection
Dendritic ulceration of the cornea

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102
Q

Is propphylaxis required for pneumonoccoal meningitis

A

No

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103
Q

What does infection with shigella cause

A

Shigellosis

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104
Q

Presentation of shigellosis

A

Dysentery
- inflammation of the colon resulting in severe abdo pain and diarrhoea

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105
Q

Transmission of shigellosis

A

Faecal oral
Sexual

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106
Q

What is the most common cause of dysentry in the UK

A

Shigella

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107
Q

Treatment of shigellosis

A

Usually self limiting and resolves in 3-7 days
More severe cases - penicillin and cephalospoirins, macrolides and quinololones

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108
Q

Diagnossis of EBV

A

Heterophile antibody test / monospot test

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109
Q

What infection is EBV most commonly assosiated with

A

Infectious mononucleosis

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110
Q

WHat other manifestiation can EBV cause

A

Splenomegaly

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111
Q

Treatment of infectious mononucleosis

A

Supportive

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112
Q

What should patients with EBV avoid

A

Contact sports - due to risk of splenic rupture

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113
Q

What commonly is assosiated with reactive arthritis

A

Chalymydia
Gonorrhoea
Campylobacter
Salmonella

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114
Q

Triad of reactive arthritis

A

Arthritis (often asymmetrical and of the lower limbs)
Urethritis
Conjunctivitis

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115
Q

HLA assosiation of reactive arthritis

A

HLA-B27

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116
Q

What is the most common CNS infection in HIV positive individuals with CD4 counts < 200

A

Cerebral toxoplasmosis (toxoplasma gondii)

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117
Q

CT scan of brain in cerebral toxoplasmosis

A

Ring enhancing lesions
- typically multiple but may be single
Surrounding oedema

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118
Q

Treatment of cerebral toxoplasmosis

A

Sulfadiazine and pyrimethamine

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119
Q

HIV patients with a CD4 < 200 should have prophylaxis to what with what?

A

PJP
Co-trim

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120
Q

What is present on examination on 50% of paitents with nec fasc

A

Subcutaneous gas or crepitations

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121
Q

Where do healthcare staff commonly transport MRSA

A

Nose

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122
Q

Investigation to dignose norcardia spp.

A

Paraffin bait

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123
Q

Test to screen for lymes disease

A

Borrelia IgG

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124
Q

What causes botulinism

A

Clostridium botulinum

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125
Q

How to catch botulinism

A

Food - improperly preserved or canned
Open wounds / IV drug users

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126
Q

Presentation of botulinism

A

Initial presentation - visual, speech or swallowing disutrbances
Descending flaccid paralysis involving motor and autonomic symptoms
No sensory change
No loss of consciousness

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127
Q

Treatment of botulinism and when should this be given

A

Botulinium antitoxin
Should be administered immediately on clinical suspecision - do not wait for laboratory confirmation

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128
Q

Presentation of tetanus

A

Trismus
Spasms
Rigidity

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129
Q

What causes epidemic typhus

A

Rickettsia Prowazekki

130
Q

How is infection of epidemis typhus spread

A

Faeces of the human body louse - pediculus humanus humanus
Can spread rapidly in where people live in crowded conditions with poor hygiene

131
Q

Presentation of epidemus typhus

A

Headache
Conjunctivitis
Orbital pain
Measles like eruption on 5th day after onset of symptoms
- get bigger until eventurally purpuric
At end of first week
- signs of meningoencephalitis/stupor/coma/extrapyramidal symptoms

132
Q

Treatment of epidemic typhus

A

Doxycycline or azithromycin

133
Q

What causes Q fever

A

Coxiella Burnetti

134
Q

Skin manifestation of secondary syphillis

A

Condylomata

135
Q

What are koplicks spots and what condition do you see them in

A

Rash in mouth - red spots with a blue/white centre
Measles

136
Q

When does symptoms after infection with salmonella occur

A

12-48 hours after ingestion

137
Q

Incubation period of staph A toxin

A

Very short - 1 - 6 hours

138
Q

How do you catch Q fever (C burnetti)

A

Spread between domestic animals by ticks, transmission to humans if of inhalation of infected dust and aerosols, and drinking unpasturised milk

139
Q

What organism in south america can burrow but not go any further than under the skin, and causes an intense itchy rash along the path of their travel

A

Ancylostoma braziliense (hookworm)

140
Q

What is the most opportunistic eye disease in patients with HIV

A

CMV retinitis
(only when CD4 counts < 50)

141
Q

Presentation of CMV retinitis

A

Unilaterally or bilaterally
Floaters
Blurred vision
Visual loss

142
Q

Retinal appearance of CMV retinitis

A

Pizza pie or cottage cheese and ketchup fundus

143
Q

Presentation of diffuse infiltrative lymphocytic syndrome

A

Presents like sjogrens syndrome but extra glandular manifestations are common
Hx of HIV
Peripheral motor neuropathy / weakness
Parotid gland involvement
Exertional dyspnoea
Aseptic meningitis
Cranial nerve palsies
Rare to have auto antibodies

144
Q

What is the most serious complication of diffuse infiltrative lymphocytic syndrome

A

Lymphocytic interstitial pneumonitis

145
Q

What is chancroid caused by

A

Haemophilus ducreyi

146
Q

Presentation of chancroid

A

Tender ulcer with a ragged edge
Readily bleeds on contact
Multiple ulcers can occur
Lymphadenopathy

147
Q

Treatment of chancroid

A

Azithromycin stat dose or
Ceftriaxone one dose IM or
cipro for 3 days or
erythromycin for 7 days

148
Q

What does hantavirus cause

A

Haemorrhagic fever with renal syndrome

149
Q

What is the medical term and organism that causes “jock itch”

A

Fungus T Rubrum
Tinea curis

150
Q

Presentation of tinea curis / jock itch

A

Similar to ringworm
Scaley, erythematous border that gradually spreads down the inner thigh
Extremely itchy

151
Q

Presentation of cutaenous leishmaniasis

A

Nodule 1-2 months post infection/sandfly bite
Gradually ulcerates
Thick fibrous crust over the surface

152
Q

Presentation of Q fever

A

Atypical pnuemonia
Incubation 14-26 days
Flu like illness - headaches, malaise, fever, dry cough
Hepatosplenomegaly and transaminitis
Endocarditis

153
Q

Investigation of Q fever

A

Serology testing for Coxiella

154
Q

Treatment of Q fever

A

Doxycycline

155
Q

What causes diptheria

A

Corynebacteriim diptheriae

156
Q

Presentation of diptheria

A

Fever
Non specific prodrome
Followed by
- membraneous pharingitis with thick, grey membranes seen on examination
- cervical lymphadenopathy and oedema leading to the characteristic “bull neck”
Rarely
- myocarditis
- heart block

157
Q

Treatment of diptheria

A

Diptheria anti-toxin
Antibiotics
Diptheria toxoid immunisation (following acute infection)

158
Q

Where is diptheria common

A

Russia

159
Q

How to quantify viral load in HIV

A

PCR

160
Q

Testing for HIV

A

ELISA

161
Q

Causative organism of malignant otitis externa

A

Pseudomonas aeruingosa

162
Q

What does malignant otitis externa involve

A

Invasion of the temporal bone and base of the skill
Can be rapidly progressive and life threatning
Facial swelling
Facial nerve involvement

163
Q

Who does malignant otitis extrna almost always occur in

A

Diabetic patients

164
Q

What is topical sprue

A

A cause of chronic diarrhoea and malabsorption assosiated with travel to the tropics (including india and SE asia)
Exact aietology unclear
Can present months or years after travel

165
Q

Presentation of topical sprue

A

Diarrhoea
Steatorrohoea
Weight loss
Malabsorption symptoms

166
Q

What should HIV anti retroviral therapy consist of

A

two nucleoside reverse transcriptase inhibitors and one other agent
e.g.
efaivranez/emtirictabine/tenfovir

167
Q

What organism is most likely to be found in the sputum of an HIV positive individual

A

Cryptococcus spp.

168
Q

How does cryptococcus generally present

A

Meningitis in immunocompromised individuals
Though pulmonary and disseminated infections may occur

169
Q

Treatment of cryptococcal meningitis

A

IV amphotericin B
in combination with flucytosine or fluconazole

170
Q

What does mefloquine (malaria prophylaxis) toxicity present as

A

Acute psychosis

171
Q

Presentation of infection with the nermatoid Loa Loa (african eye worm)

A

slow passage across eye - can be sensed by patient
skin lesions confined to extemeties i.e. arms and legs
Lesions knwon as calabar swellings
Can be asymptomatic
Severe itching
Myalgia
Arthralgia
Tiredness
Urticaria

172
Q

What is medetiranian spotted fever caused by

A

Rickettsia conorrii

173
Q

How do you establish medeterianian spotted fever from other vector borne infections

A

Skin lesions eschar
- blackened centre of tick bite

174
Q

What is enteric fever and what causes them

A

The collective term for typhoid and paratyphoid fevers
Salmonella typhi or salmonella paratyphi

175
Q

Presentation of enteric fever

A

High fever and flu like symptoms
Abdomainal pain / constipation / diarrhoea may be present
Relative bradycardia
Blanching rash (rose spots)
Splenomegaly

176
Q

What is seen in blood cultures in enteric fever

A

gram neg rods (salmonella species)

177
Q

Key feature of mumps

A

Parotitis

178
Q

WHat happens in 10% of patients with mumps and the treatment

A

Viral meningitis
Resolves spontaenously

Orchitis
Specialist review

179
Q

Is mumps a notifiable disease

A

Yes

180
Q

Mechanism of action of vancomycin

A

Prevents synthesis of polymers for the bacterial cell wall

181
Q

What is IRIS (immune reconstitution inflammatory syndrome) and how does it present

A

Seen in HIV positive patients after commencing antiretrovirals
Presents as a paradoxical worsening of other infections
Tends to occur in patients with a very low CD4 count

182
Q

Which anti retroviral used in HIV is commonly assosiated with a rash

A

Nevirapine

183
Q

What do the questions commonly use as an antibiotic for cellulitis if someone is allergic to penciillin

A

Clindamycin

184
Q

What should be suspected in every case of fever in a returning traveller, despite prophyaxis

A

Malaria

185
Q

What can occur in assosiated with P falciparum infection

A

Blackwater fever
Intravascular haemolysis
Characteristic dark urine

186
Q

Treatment of severe / cerebral malaria

A

IV artesunate
IV quinine if above not available

187
Q

PEP post needlestick injury from higher risk patient

A

3 anti retroviral agents for 1 month

188
Q

What causes paragonimiasis

A

Trematode fluke - paragonimus westermani
(ingested from an infected crustacean)

189
Q

Features of paragonimiasis

A

Penetrate gut wall, peritoneum and the lungs
Cellular reaction, eosinophilia and haemorrhage
Granulomatous response

190
Q

Treatment of african tick typhus

A

Doxy

191
Q

Is yellow fever a live vaccine

A

Yes

192
Q

What causes a viral meningitis caused by the mumps virus

A

Paramyoxvirus

193
Q

Treatment of schistosomiasis

A

Praziquantel

194
Q

Treatment of Loa loa / loiasis

A

Diethylcarbamazine (DEC)

195
Q

Treatment of diardiasis

A

Tinidazole

196
Q

Key features of strongylodies infection

A

Urticarial rash
Abdominal symptoms
Peripheral blood oesinophilia

197
Q

Treatment of storngylodies infection

A

Ivermetcin or albendazole

198
Q

Which part of the life cycle occurs in P vivax but not P falciparum

A

Hypnozoites

199
Q

What are hypnozoites

A

Represent the dormant liver stage of p vivax and ovale
can cause late relapses after treatment
Not in p falciparum

200
Q

Common pathogens causing bacterial meningitis in the immunocompromised

A

Strep pneumoniae
Neiserria meningitis
Listeria monocytogenes
Aerobic gram neg bacilli

201
Q

Which organism is most likely to cause a culture negative endocarditis

A

Coxiella burnetti (Q fever)

202
Q

Causes of culture negative endocarditis

A

Prev antibiotic administration
Brucells
Bartonella
Corxiella burnetti
Fungal causes
Malignancy
SLE

203
Q

Virus causing kapsois sarcoma

A

Human herpesvirus 8

204
Q

Prophylaxis for meningococcal B

A

Cirpofloxacin

205
Q

Treatment of CMV encephalitis in HIV patients

A

Ganciclovir

206
Q

What transmits epidemic typhus

A

Human body louse

207
Q

Commonest cause of epididymo-orthitis in < and > 35s

A

< - STIs
> - gram neg enteric bacteria

208
Q

Treatment of epidiymo orchiritis if NOT suspecting an STI

A

Ofloxacin

209
Q

What causes yellow fever

A

Flavivirus

210
Q

Presentation of yellow fever

A

Can be mild
Severe flu like illness
Pyrexia up to 40C
Epigastric pain
Vomiting
Bradycardia (fagets sign) on 2nd day of the illness

Recovery phase

Severe fever again
Jaundiced
Hepatomegaly
Bleeding from gums / bruising / haematemesis / melena

211
Q

Treatment of yellow fever

A

Supporitve

212
Q

Investigation for group A strep

A

Anti-streptolysin O titre

213
Q

WHat can a high eosinophil count indicate

A

Helminth infection

214
Q

Treatment of decomp liver failure in the context of chronic hep B

A

Entecavir

215
Q

When is delayed initiation of ART considered

A

When CD4 count < 50

216
Q

50% of patients have what

A

Pleural effusion

217
Q

WHat organism causes cat stratch disease

A

Bartonella Heneslae

218
Q

Pathology of bacterial vaginosis

A

Healthy microbiota of female GU tract (lactobacillus, L crispatus, L jensii and Liners ) are replaced by predominantely anaerobic micro organisms, such as gardenerlla vaginalis or prevotella, peptosteptococcus and bacteriodes spp.

219
Q

WHat type of mosquites vector all malaria

A

Anopheles

220
Q

What type of diseases do the aedes mosquito vector

A

Dengue
Yellow fever
Zika

221
Q

Which type of malaria has the shortest incubation

A

Falciparum

222
Q

What is PML caused by

A

JC virus

223
Q

Presentation of PML

A

Focal, progressive neurology due to white matter demhyelination
Occurs weeks to months

224
Q

Guidelines for travel for patients with active TB

A

IF
- have evidence of drug susceptible disease or no signs of drug resistance AND
- Do not have a clinical or public health need for admission to hospital
Can travel two weeks after starting therapy
Different if HIV positive or immunosuppressed

225
Q

Malaria types capable of true dormancy

A

Vivax and ovale

226
Q

Where can you catch p. ovale

A

only in sub saharan africa

227
Q

Fundoscopy of HSV keratitis

A

Cornea - dendritic ulcer
Ulcer with linear blanching pattern
Terminal bulbs
Swollen epithelial borders
Central ulceration through the basement membrane

228
Q

What serological tests would indicate if someone had previously had Hep B but has now completely cleared the infection

A

Postivie for both core and surface antibodies
Negative surface antigen

229
Q

WHat is the marker of infection serologically for Hep B

A

Surface Antigen

230
Q

Organisms that cause bloody diarrhoea

A

Salmonella
Shigella
Enterohaemorrhagic E coli
Entamoeba histolytica (slower course of disease)

231
Q

S/E ethambutol

A

Ocular complications / optic neutritis

232
Q

S/E of isoniazid

A

Drug induced hepatitis
Peripheral neuropathy

233
Q

S/E Pyrazinamide

A

hepatotoxic

234
Q

S/E rifampicin

A

Pink/orange secretions
Drug induced hepatitis
Interacts with alot of other medications

235
Q

Which anti-malarial agent is affective against liver hypnozoites

A

Primaquine

236
Q

Is streptococcus gram negative or positive

A

positive

237
Q

Is neisseria meningitidis gram negative or positive

A

negative

238
Q

What is trachoma and what is it caused by

A

Chronic keratoconjunctivitis
Chlamydia trachomatis

239
Q

Patients with advanced HIV infection and CD4 counts < 50 are at high risk of what

A

Disseminated mycobacterium avium complex (MAC) infection

240
Q

In questions . sitting near a river might indicate what

A

Possibility of exposure to rats urine (leptospirosis)

241
Q

Causative organism of prosthetic joint infections that are chronic

A

Staphlococcus epidermi

242
Q

Is chicken pox a live vaccine

A

yeS

243
Q

What kind of bacteria is legionella

A

gram negative rod

244
Q

Treatment for leprosy and for how long

A

Dapsone, clofazimine, rifampicin
At least 2 years

245
Q

What bacteria can you get consuming soft cheeses

A

Listeria

246
Q

What is the concern after a bat bite in the UK

A

Rabies

247
Q

Treatment of high risk exposure to rabies in a non immune patient

A

Both rabies immunoglobulin and vaccine

248
Q

Treatment of low risk exposure to rabies / someone who has been previously vaccinated

A

Vaccine course only

249
Q

What kind of bacteria is gonorrrhoea

A

Gram negative diplococci

250
Q

What is an indium labelled leukocyte study for

A

Detecting occult abcesses in patients of PUO whos conventional scans have failed to detect a source of infection

251
Q

When does the jarish Herxheimer (JH) typically occur

A

Sphirochete infections e.g. lymes disease
Syphillis
Leptospirosis
Symptoms follow the first dose of antibioticd

252
Q

What should be avoided in a pregnant patient with HIV

A

Foetal blood sampling

253
Q

Treatment of chronic hep C infection of genotypes 1 or 4, with or without compensated cirrhosis

A

Daclatasvir and sofosbuvir

254
Q

Treatment of genital warts secondary to HPV

A

Topical podophyllotoxin

255
Q

What virus causes kaposis sarcoma

A

HHV-8

256
Q

What virus causes hand foot and mouth disease

A

Coxsackie virus

257
Q

Presentation of HFM disease

A

incubation 3-5 days
Followed by flu like symptoms
Yellow grey ulcers in mouth
Vesicular rash on hands and feet
Episodes often self limiting but can have complications - myocarditis, meningitis, encephalitis

258
Q

Treatment of HFM disease

A

Supportive

259
Q

How does s. schnekkii infect humans

A

Lives on soil and plant matter
Enters skin through cut or scrape

260
Q

Treatment of s. schnekki infections

A

Reddish, non tender, maculopapular lesion at the site of innoculation (10 weeks after)
Over next several weeks. similar nodules form along proximal lymphatic channels
These break down and form a row of ulcers

261
Q

Diagnosis of s. schnekki infections

A

Culture of biopsy samples on Sabouraud dextrose agar

262
Q

Treatment of s. schnekki infection

A

Itraconazole
More severe / immunocompromised - IV amphotericin B

263
Q

Which adults should receive aciclovir for chicken pox

A

If rash < 72 hours of onset and
- immunocompromised or
- non truncal parts of body or
- mod - severe pain or
- severe rash

264
Q

What renal problem can secondary syphilis cause

A

Acute glomerulonephritis

265
Q

Bacteria that are gram positive cocci

A

Staph
Strep
Enterococci

266
Q

Bacteria that are gram positive rods

A

Actinomyces
Bacillus
Clostridium
Diptheria
Listeria monocytogenes

267
Q

Bacteria that are gram negative cocci

A

Neisseria
Moraxella
Brucella

268
Q

Bacteria that are gram negative rods

A

Legionella
Campylobacter
E coli
Pseudomonas
Proteus
Salmonella

269
Q

What is the procedure if someone has a needle stick injury from someone who is positive for Hep C

A

Hep C virus ribonucleic acid monthly surviellance
If signs of seroconversion - treatment with antivirals can be initiayed

270
Q

What abdominal symptom does giardiasis present with whihc the mechanism of which is not fully understood

A

Malabsorptions symptoms

271
Q

How to differentiate between the 3 causative organisms of asthelets foot

A

Trichophyton - multiple small microconidia
Microsporum - produce single microconidia or multiseptate macronconidia
Epidermophyton - do not produce conidia

272
Q

What is the CD4

A

T-helper cell

273
Q

Cancer assosiations of EBV

A

Gastric cancer
Nasopharyngeal carcinoma

274
Q

Definition of treatment failure in TB

A

Positive cultures after 4 months of therapy

275
Q

What causes chancroid

A

Haemophilus ducreyi

276
Q

Presentation of chancroid

A

Incubation 4 - 7 days
Erythematous papule forms
Subsequently breaks down into a painful ulcer
Painful inguinal lymphadenopathy develops, unusually unilaterally, which can suppurate
Several ulcers can merge to form giant serpiginous lesions

277
Q

Diagnosis of chancroid

A

Isolating the organism from swabs taken from the lesion and cultured on chocolate based media

278
Q

Treatment of chancroid

A

Single dose azithromycin
IM cef
3 day course erythromycin

279
Q

When should oropharyngeal anthrax be considered

A

Patients who present with fever, severe pharyngitis and neck oedema
Particularly if there is consumption of raw or undercooked meat

280
Q

Which vaccine can HIV positive patients not have

A

BCG

281
Q

WHat can be used to cover for listeria in meningitis in patients with a penicillin allergy

A

Co-trimoxazole (instead of amoxicillin)

282
Q

Treatment of falciparum malaria

A

Artemether with lumefantrine

283
Q

Who is oral hairy leukoplakia seen in

A

HIV positive patients

284
Q

Causative organism of ora hairy leukoplakia

A

EBV (in HIV positive patients)

285
Q

Presentation of oral hairy leukoplakia

A

Similar appearance to candida
Irregular white patches on tongue and oral mucosa
Covered in tiny hair like projections occuring along the folds
Cannot be dislodged with scraping

286
Q

Treatment of oral hairy leukoplakia

A

Managing underlying cause

287
Q

WHat CD4 count do you need to have to get a live vaccination with HIV

A

> 200

288
Q

What causes impetigo

A

Staph aureus
Occassionally strep pyogenes

289
Q

Treatment of impetigo

A

Topical fusidic acid

290
Q

What causes schistocytes on a blood film

A

Acute haemolytic anaemia

291
Q

Presentation of congenital varicella syndrome

A

LBW
Characteristic abnormalities of the skin arms, legs, hands and extremeties, brain and eyes
Symptoms may vary depedning on timing of infection

292
Q

Which ART is known to cause renal stones in 10% of patients who take it

A

Indinavir

293
Q

Usual firm line treatment for ESBL

A

Meropenem

294
Q

Infection period of chickenpox

A

1-2 days before the rash until all of the lesions are crusted and dry

295
Q

Statin lowering drug that is preferred in HIV patients

A

Pravastatin

296
Q

What causes bacterial vaginosis

A

Garnderella vaginalis

297
Q

What causes the weakness in botulism

A

Exotoxin release

298
Q

What suggests lupus vulgaris

A

A chronic progressive irregular plaque like lesion with central scarring from an invidual from an endemic area

299
Q

What is the lupus vulgaris the most common manifestiation of

A

cutaneous tuberculosis

300
Q

Malaria prophylaxis in patients with epilepsy

A

Doxycycline
Atovaquone with proguanil hydrochloride (Malarone)

301
Q

WHat does an increasing PR interval in a patient with IE indicate

A

Aortic root abscess / sign of uncontrolled infection

302
Q

Commonest cause of encephalitis in the UK

A

HSV

303
Q

Which ARVs have the S/Es of hyperlipidaemia

A

Ritonavir
Lopinavir

304
Q

Mechanism of action of mebendazole

A

Inhibitor of tubulin polymerisation

305
Q

What does poor HIV control and middle/lower third oesophageal ulcers indicate

A

CMV infection

306
Q

Treament of CMV in HIV individuals

A

Valganciclovir

307
Q

Causative organism of BV

A

Gardnerella vaginalis

308
Q

What to do if a pregnant lady is exposed to chicken pox

A
  1. Varicella zoster antibody testing
    - if positive - no further intervention required
    - if negative - VARICELLA ZOSTER IMMUNE GLOBULIN

If develops symptoms (aciclovir within 24 hours of onset)

309
Q

What is the fancy name of the worm seen in the UK

A

Enterobius vermicularis

310
Q

Investigation of leptospirosis

A

Microscopic agglutination test

311
Q

Treatment of C diff

A
  1. Vanc
  2. Metronidazole
312
Q

Most common adverse effect of immunoglobulin infusions

A

Headache

313
Q

Treatment of cellulitis in a DIABETIC patient

A

co-amoxiclav

314
Q

What causative organism would you think of if someone has pharyngitis, and develops a non blanching maculopapular rash around 48 hours of commencement of antibiottics treatment

A

EBV

315
Q

Treatment of syphillis in a penicillin allergic patient

A

Doxycycline

316
Q

Treatment of UTI in a breastfeeding woman who is pen allergic

A

Cefixime

317
Q

Ascitic / abdominal involement TB - treatment duration

A

6 months

318
Q

Investigation of cutaneous leishmaniasis

A

Punch biopsy from edge of an ulcer

319
Q

Prophylaxis of close contacts of patients diagnosed with meningococcal meningitis

A

Single dose of ciprofloxacin

320
Q

Common cause of insect bites infection

A

Strep pyogenes

321
Q
A

MRCP - Part 1 (20 decks)

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