ID Flashcards
before starting on TB tx, what Ix need doing?
UE
LFT - hepatotoxic
vision testing
FBC
how many doses of tetanus generally gives lifelong protection>?
5 (2 months 3 months 4 months 3-5 years 13-18 years)
36M-ED 1/7 hx SOB and cough. hr 126, bp 103/57 mmHg. RR 28, sats 93% air, t 39.6ºC. 8 months previously he underwent an emergency laparotomy and splenectomy following trauma. dx?
pneumococcal sepsis
following splenectomy this risk is highest in first 2 years
strep pneumo, Hib commonest
A 24-F->GP 3/7 diarrhoea. No blood in the stools or history of fever. BO 3x/day with watery stool. BG: RA. She has well-controlled on methotrexate and adalimumab. She does not smoke or drink alcohol.
Very mild abdominal tenderness. There is no guarding and her abdomen is soft. Bowel sounds are present.
Stool microscopy, which grows Campylobacter jejuni. mx?
clarithromycin
normally watch and wait but as immunosuppressed and severe infection give abx
type of bacteria is campylobacter jejuni?
gram negative bacillus
A 33-M HIV positive presents with a 2 day history of diarrhoea. What is the most likely cause of his diarrhoea?
cryptosporidium
UTI in pregnant woman 10/40- abx?
Pregnant women with a UTI: 7/7 nitrofurantoin is first-line unless the woman is close to term
Results of a human immunodeficiency virus (HIV) test. The antibodies and p24 antigen are reported as negative. You check the records and find it was requested by your colleague who is on holiday. The patient is a man who had requested an HIV test after an encounter with a sex worker; your colleague had asked him to attend the sexual health clinic but he had declined, wanting tests done via the GP. The HIV test had been taken 4 weeks after the episode.
What should the patient be told about the result?
HIV unlikely but offer a test at 12 weeks post-exposure
in asx pts offer first test 4 weeks after exposure
A 35-M who is known to have advanced HIV disease presents with dysphagia and odynophagia. What is the most likely cause of his problems?
oesophageal candidiasis
A 20-F 16/40 pregnant presents with pain passing urine and an irritating rash. Tender, red, vesicular rash on her vulva. Urine dipstick shows both blood and white cells. What is the best treatment?
Oral acyclovir delivery by C section
HSV
which antiviral in HSV always?
acyclovir
39-M returns from a two week business trip to Kenya. Four weeks after his return he presents to his GP complaining of malaise, headaches and night sweats. On examination there is a symmetrical erythematous macular rash over his trunk and limbs associated with cervical and inguinal lymphadenopathy. What is the most likely diagnosis?
HIV seroconversion
Bilateral conjunctivitis, bilateral calf pains and high fevers in a sewage worker suggests what?
leptospirosis
rose spot’ macular rash and a relative bradycardia.??
enteric fever
If a patient has had 5 doses of tetanus vaccine, with the last dose < 10 years ago???
no futher jab - supportive mx
The CSF results are consistent with bacterial meningitis……>
low glucose, high protein, high polymorphs
meningitis prophylaxis?
cipro
Renal transplant + infection ?
CMV
61-M diabetic foot clinic because of a chronic ulcer on his left leg. The ulcer has been present for the past 5 months and is well demarcated with no sensation at the base of the ulcer. He has grown the same bacteria from swabs taken from the ulcer multiple times. HR 81, BP 132/83 temp 37.1ºC. The base is wet with a pale green slough over it and smells damp and offensive.
Which organism is most likely to be responsible for this ulcer based on this clinical picture?
pseudomonas aeruginosa
common cause of chronic wound infections
A 27-M returns from a recent trip to South America. -> ED with symptoms of fever, headache, arthralgia, constipation and abdominal pain. On examination, he has splenomegaly and blanching maculopapular rose spots on his trunk. What is the most likely diagnosis?
typhoid fever
salmonella typhi causes rose spots too
Yellow fever presents with
fever, chills, headache, backache, and muscle aches, but it would not present with a rash
incubation 2-14/7
what type of fever is typhoid fever?
enteric fever
21-M ->ED 5-week history of progressive lethargy and intermittent dizziness and palpitations, particularly on exertion and often related to shortness of breath. Today he has had a syncopal episode and is concerned that there may be something wrong with his heart as he has a strong family history of heart disease.
No PMH, ex-smoker with a 3 pack year history and takes no recreational drugs. He has recently emigrated from India and is working in an office. Weight stable for the last year and he reports no change in bowel habit or appetite. Itchy rash on his feet appearing several months ago, but this self resolved.
anaemic. eosinophillia. cause?
hookworm can cause IDA in endemic areas
travel
pig meat related is which hepatitis in exams?
hep E
BCG measles, mumps, rubella (MMR) influenza (intranasal) oral rotavirus oral polio yellow fever oral typhoid these are all??
live attenuated vaccines
CI in HIV pts
rabies
hepatitis A
influenza (intramuscular)
these are all??
inactivated vaccines
tetanus
diphtheria
pertussis
these are all?
toxoid - inactivated toxin vaccine
Disseminated gonococcal infection triad =
tenosynovitis, migratory polyarthritis, dermatitis
29F->GP past 3 weeks noticed a rash on her thighs which then appeared on her forearms. It is dry, itchy and red. Then she began to have pain in her knees which was worse on movement, the same pain then spread to her left wrist and began to limit her movement. In the last week she has noticed difficulty in moving some of her right fingers from a bent to straight position, it being painful to do so. Cultures sent. What is most likely to been seen on microscopy?
gram negative diplococci
gonococcal - niesseria gonorrhoea
Gram negative rods with a single flagella would be
pseudomonas aeruginosa
Gram-positive cocci in clusters is
s. aureus
gram-positive diplococcus that is often found in the reproductive tract but is does not usually disseminate.
GBS
Gram-positive flagellated rods are
listeria monocytogenes
UTI and on MTX: tx?
nitrofurantoin
elderly gentleman presents with a three day history of bloody diarrhoea and feverishness. He has no significant travel history. His past medical history is listed as hypertension, osteoarthritis and gout. On examination his temperature is 38.0ºC, heart rate 95/min, blood pressure 120/80 mmHg and his abdomen is soft and non-tender. A stool sample has grown Salmonella. What is the best treatment?
cipro
26-M presents with nausea, malaise and jaundice. He returned 3 weeks ago from a holiday to India. Moderate hepatosplenomegaly and yellowing of the sclera. He also has dark urine and pale stools. dx?
Hep A
faeco-oral transmission
pregnant woman brings her 5-year-old son to the GP because of a rash present on his cheeks and arms, he is otherwise well. She denies any diarrhoea or vomiting but is concerned because his school said he cannot come in whilst he has this rash.
Given the likely diagnosis, what would be the most appropriate action?
check maternal IGs as parvovirus B19 risk to pregnancy;
hydrops
kid can go to school - not infectious when rash has developed
63-F farmer presents with a severely painful right leg. She accidentally impaled herself with a pitchfork whilst moving hay 12 hours ago. The wound was approximately 1cm deep, stopped bleeding within 20 minutes, and she covered it with a plaster. Over the last 12 hours, the pain has been increasing steadily and is now very severe. She has no other symptoms. She takes metformin for T2DM. HR 85, RR 18, BP 124/82, temp 38.5ºC. 1cm wound on her lower right calf. It is surrounded by an area of prominent erythema and swelling that is approximately 15cm at its widest diameter. There is also a very dark purple area around the wound. There is one blister with foul-smelling discharge. The wound is very tender.
An emergency x-ray demonstrates air bubbles in the tissues. Swabs are taken and broad-spectrum antibiotics are started. What is the most likely organism to be isolated?
clostridium perfingens
Gas gangrene is caused by C. perfringens
C perfringens is what on gram stain?
gram positive bacillus that is spore-forming
A 33-year-old woman who was diagnosed as having HIV-1 two years ago is reviewed in clinic. She is fit and well currently and has no symptoms of note. The only medication she takes is the occasional paracetamol for tension headaches. CD4 325 * 106/l
What is the most appropriate action with regard with to anti-retroviral therapy?
start now
everyone offered ART regardless of CD4 count
The flu-like symptoms, bilateral consolidation and erythema multiforme (target lesions) point to a diagnosis of???
mycoplasma pneumoniae
can also cause immune-related neuro disorders (GBS-like sx)
ix mycoplasma?
mycoplasma serology
28F -> ED with a prior history of chlamydia, low-grade fever and abdominal pain that has worsened over the past 6 hours. She says the pain is worst on the right-hand side and radiates into the shoulder.
what is this cx of PID?
Fitz-hugh-curtis syndrome
liver inflammation
which abx should be added to tx of pneumonia caused by influenza?
fluclox
pneumonia post-influenza infection - staph aureus
if ?nec fasc what is mx?
IV abx + SURGICAL debridement
Immunocompromised patients with toxoplasmosis are treated with ???
pyrimethamine plus sulphadiazine
only pyrimethamine in non-IC pts but severe inf - if not severe - not tx
strep pyogenes rarely causes which infection type?
pneumonia
which organism can cause hyponatraemia and cause a pneumonia?
legionella
also bilat infiltrates, brady, confusion, LFTs off
The first line treatment in amoebiasis is:
metronidazole
28-F sex worker -> ED: severe headache and fever. On examination you elicit some neck stiffness and and mild photophobia and as such a lumbar puncture is performed. The results of the lumbar puncture show a yeast and a capsule in the CSF stained with India ink.
dx?
cryptococcal meningitis
28-F 10/40 pregnant. The urine sample was collected during her recent appointment with her midwife and the result has returned showing the presence of Escherichia coli. asymptomatic. tx?
7 day course nitrofurantoin (should be avoided near term), amoxicillin or cefalexin
Incubation period GE pathogens:
1-6 hrs: Staphylococcus aureus, Bacillus cereus*
12-48 hrs: Salmonella, Escherichia coli
48-72 hrs: Shigella, Campylobacter
> 7 days: Giardiasis, Amoebiasis
which type of pneumonia associated with erythema multiforme (target lesions on skin)?
mycoplasma pneumoniae
tx mycoplasma pneumonia?
doxy/macrolide
most common cause of travellers diarrhoea?
e coli
mx of red man syndrome with vancomycin?
stop vanc and infuse at a lower rate
42-F ID ward due to an erythematous lesion on her ankle and some periorbital oedema which she noticed weeks after returning from a trip to South America. She is diagnosed with Chagas’ disease. She is incredibly worried about her prognosis and wants to begin treatment immediately.
Which severe complication is it most important to warn her about?
cardiomyopathy - do an echo
Trypanosomiasis: 2 types:
Two main form of this protozoal disease are recognised - African trypanosomiasis (sleeping sickness) and American trypanosomiasis (Chagas’ disease).
23-M-> GP with a one week history of pain on urination and a pus-like discharge from the end of his penis. There is no history of haematuria, fever, abdominal pain or joint pain and the patient is otherwise well. He is sexually active and has had penetrative sex with three women in the past two months.
Examination of the genitalia is unremarkable.
chlamydia trachomonatis likely
urethritis+/-discharge
chlamydia trachamonatis ix?
first catch urine nucleic amplification test
tx chlamydia?
either oral doxycycline for 7 days or single dose of oral azithromycin
(never doxy if pregnant)
The incubation period of Ebola virus is
2-21 days
A description of the contents for amoebic liver abscesses is described as ‘anchovy sauce’ - organism?
entamoeba histolytica
cause dysentery
what is the most common cause of type 2 necrotising fasciitis??
strep pyogenes
Bacterial vaginosis in pregnancy: abx??
metronidazole PO ( still ) even when breast feeding - high doses stat are CI
Genital wart treatment??
multiple, non-keratinised warts: topical podophyllum
solitary, keratinised warts: cryotherapy
2nd line top imiquimod
four fleshy, protuberant lesions on her vulva which are slightly pigmented????
genital warts
MSM: ano-oral sex: which STI commonest
Although Hepatitis B is associated with sexual transmission, anal-oral sex is responsible for the transmission of Hepatitis A
what can give false mantoux negative?
long term steroid use eg well controlled UC
sarcoidosis
AIDS
lymphoma
multiple erythematous ulcers over the external genital area, and there is evidence of excoriation. No discharge can be seen.
dx? ix?
genital herpes
NAAT
tx genital herpes?
PO aciclovir
Erythema chronicum migrans is an early feature of ??
lyme disease
‘bulls eye’ rash
later can be bilat facial nerve palsy
spirochaete Borrelia burgdorferi causes:
lyme disease
Atypical lymphocytes - ?
glandular fever
infective mononucleosis
constipation points to which causative organism??
typhoid
what is the antibiotic of choice for cellulitis in pregnancy if the patient is penicillin allergic?
erythromycin
Parvovirus b19: IgG negative & IgM positive mx?
non-immune. Recent parvovirus infection in last 4 weeks. Refer immediately for further tests/fetal medicine.
which 2 compounds make up co-amoxiclav?
amoxicillin
clavulanic acid
what purpose does clavulanic acid serve in co-amox?
B-lactamase inhibitor
not effective itself as an abx, overcomes resistance in bacteria which produce B-lactamase
what is Augmentin?
co-amox
how does levofloxacin kill bacteria?
quinolone
inhibits DNA gyrase and topoisomerase and prevents the supercoiling of the DNA during replication
bacteriocide
Lyme disease in asymptomatic patients bitten by a tick mx?
no treatment - no abx
first line in the treatment of Lyme disease?
doxycycline
33-M HIV positive -> ED confusion and drowsiness. He has been complaining of headaches for a number of days. hr 90, BP 104/78 temp 37.2ºC. He is confused GCS 14. There is no photophobia or neck stiffness. His ID consultant reports that he is prescribed HAART but his compliance is poor and he often misses clinic appointments. CT brain (with contrast): Multiple hypodense regions predominantly in the basal ganglia which show ring enhancement. Minimal surrounding oedema. No mass effect. dx?
cerebral toxoplasmosis
HIV, neuro symptoms, multiple brain lesions with ring enhancement -
toxoplasmosis
CSF: high opening pressure, India ink test positive in which cerebral infection?
cryptococcal
which infection is due to infection of oligodendrocytes by JC virus (a polyoma DNA virus)?
Progressive multifocal leukoencephalopathy (PML)
10-M ->GP. Dull headache and neck pain since last night. Looks unwell and there is an erythematous non-blanching rash across his legs. HR 140, BP 100/60, RR 24, temp 39°C. Given the likely diagnosis, you consider administering antibiotics to the child. The father reports that his son developed a rash after being given flucloxacillin for a different illness. What is the immediate management of this clinical scenario?
IM BenPen and transfer to hospital
doesn’t matter about the previous rash - this isn’t a CI
if previous anaphylaxis to pen - transfer w/o abx
Lyme disease can be diagnosed clinically if?
erythema migrans present - PO doxy la
Necrotising fasciitis: most commonly affected site???
perineum
what is erysipelas?
superficial cellulitis
mx erysipelas?
fluclox
what type of virus is Hep A?
RNA picornavirus
MSM get vaccine vs this
31-F noted an offensive, fishy vaginal discharge. She describes a grey, watery discharge. What is the most likely diagnosis?
Bacterial Vaginosis
clue cells
Bacterial vaginosis - overgrowth of predominately which organism?
gardnerella vaginalis
pH >4.5
treatment of choice for Gonorrhoea?
IM ceftriaxone stat dose
if don’t want IM - PO cefixime + azithromycin
5M known sickle cell disease -> ED 1/7 hx fevers, arthralgia and a facial rash, associated with worsening shortness of breath on exertion and lethargy. He also experienced 2 nosebleeds yesterday, which he has never had before. Cause of his symptoms?
erythema infectiosum
parvovirus b19 -> aplastic anaemia crisis in patients with sickle cell disease/HS
what blood result is associated with cholera?
hypoglycaemia
also hypokalaemia and metabolic acidosis