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MRCP 2 > ID & GUM > Flashcards

ID & GUM Flashcards

1
Q

amoebiasis treatment

A

metronidazole to kill active parasites
diloxanide furoate to kill cysts
aspiration for large liver abscesses

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2
Q

abx that disrupt folate synthesis

A

trimethoprim
sulfonamides

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3
Q

abx that disrupt bacterial ribosome function

A

30S:
tetracyclines, aminoglycosides

50S:
macrolides, clindamycin, linezolid, chloramphenicol

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4
Q

vanc and gent adverse effects

A

red man
ototoxic
nephrotoxic

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5
Q

macrolide adverse effects

A

P450 inhibition
cholestasis
thrombophlebitis
QTc prolongation

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6
Q

abx c/i in myaesthenia gravis

A

gentamicin

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7
Q

galactomannan antigen is present in

A

aspergillosis

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8
Q

ABPA hypersensitivity type

A

1 and 3

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9
Q

aspergillosis tests

A

invasive and chronic: serum galactomannan
ABPA: IgE, aspergillus specific IgE and IgG, eosinophilia
CPA: IgG

XR nodules, consolidation, infiltrates, cavities
HRCT: nodules, halo, air crescent
HRCT/MRI brain: focal lesions, SOL, abscesses, haemorrhagic lesions

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10
Q

meningitis organisms

A

neisseria
strep pneumoniae
hib

in neonates: strep agalactiae, ecoli, strep pneumoniae, listeria

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11
Q

meningitis treatment

A

benpen stat (300/600/1200mg)
IV ben pen/cefotaxime/chloramphenicol
add vanc if foreign travel

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12
Q

meningitis prophylaxis

A

ciproflox stat
for contacts within 7 days prior to onset of illness

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13
Q

normal vaginal pH

A

< 4.5

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14
Q

BV micro-organisms

A

gardnerellam atopobium
prevotella
mycoplasma hominis
mobiluncus

reduced lactobacilli

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15
Q

brucellosis pathophysiology

A

invades nearby mucosa
lymphatic spread
> haematogenous spread
> reticuloendothelial system

re-infection can occur as immunity following infection is not adequate
incubation days to months

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16
Q

brucellosis treatment

A

dual or triple therapy 6 weeks
notifiable disease
specialist involvement if pregnant or < 8y

PO doxy and IM strep
or
PO quinolone and rifampicin
or
PO doxy and rifampicin

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17
Q

diagnosing c diff

A

stool PCR and glutamate dehydrogenase immunoassay
50% of patients have plaques on colonoscopy/sigmoidoscopy

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18
Q

cellulitis microorganisms

A

strep pyogenes and staph aureus
pseudomonas aeruginosa (hot tubs, sponges)
vibrio vulnificus (saltwater)
aeromonas hydrophilia (freshwater)
erysipelothrix (butcher, vet)
mycobacteria marinum (aquarium)
pasteurella, capnocytophaga (dog/cat bite)
eikenella (human bite)
strep moniliformis (rodent bite)
strep pneumoniae, haemophilus, anaerobes (injury, burns, immunocompromised)

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19
Q

abx for cellulitis with lymphoedema

A

amox

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20
Q

avoiding sexual contact with chlamydia

A

additional 7 days after treatment with azithromycin
test after 3-6 months for re infection

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21
Q

chlamydia treatment if pregnant/breastfeeding

A

azithromycin
amox
erythromycin
test of cure after 3 weeks if pregnant

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22
Q

botulism

A

gram positive bacillus
flaccid paralysis
food born/wound/infant/inhalation bioterrorism
toxins A, B, E cleave SNARE proteins at NMJ
> inhibits release of ACh

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23
Q

botulism presentation

A

blurred vision, diplopia, ptosis (CN III, IV, VI)
dysarthria, dysphagia (oculobulbar or CN IX, X, XII)
symmetrical descending flaccid paralysis
absent deep tendon reflexes
urinary retention, constipation, postural hypotension, dry mouth
GI symptoms if food borne or infantile
typically afebrile

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24
Q

management of botulism

A

mechanical ventilation if upper airway compromise
horse heptavalent antitoxin for adults
IVIG for infants
surgical debridement for wound botulism

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25
cryptosporidiosis
most common cause of infectious diarrhoea in pt with HIV contaminated water or food with oocysts oocytes shed for 7 days chronic infection in immunocompromised dx: stool microscopy, stool antigens, stool PCR tx: mostly supportive, nitazoxanide
26
congenital CMV
sensorineural deafness LD, developmental delay sight problems
27
CMV transmission
blood, transplant sexual contact saliva placental latency sites: endothelial cells of arterial walls, T cells
28
CMV treatment
valganciclovir or ganciclovir 1 month for immunocompromised or congenital infection
29
dengue vaccine
should only be used in people previously infected due to increased risk of severe dengue
30
diagnosing dengue
RT PCR NSI ELISA IgM and IgG (IgG indicates past infection)
31
e coli virulence factorw
verotoxin (shiga like) > bloody diarrhoea, HUS heat stable/labile enterotoxins > watery diarrhoea p fimbriae > UTI K1 capsular polysaccharide > neonatal meningitis, pneumonia lipopolysaccharide > bacteraemia, septic shock
32
e coli subtypes
EIEC (invasive) > dystentery ETEC (toxigenic) > watery diarrhoea, heat labile and stable toxins EPEC (no toxin) > diarrhoea EHEC > HUS, bloody diarrhoea EAEC (aggregative) > persistent diarrhoea
33
filariasis
mosquito borne (anopheles, culex) dx: microfilariae on blood film, anti filarial IgG4 labs may be negative as lymphoedema can develop years after infection preventative albendazole/ivermectin/DEC tx: DEC tropical pulmonary eosinophilia is a complication
34
dermatophytes vs yeasts
Dermatophytes: trichophyton rubrum/interdigitale epidermophyton floccosum (tinea pedis/corporis/cruris/unguium) yeasts: candidiasis pityrosporu, orbicularis (pityriasis versicolour) cryptococcus and histioplasmosis are dimorphic
35
cryptococcus presentation
immunocompromised host subacute (1-2 weeks) headache, fever, confusion
36
histioplasmosis
found in soil containing bird/bat droppings affects immunocompromised spores turn into yeast cells at body temp > macrophages ingest alveoli > microconidia transform into yeasts asymptomatic or flu like symptoms dx: CXR often normal or may show calcified granulomas urine PCR and antigens serum antibodies after 2-6 weeks tx: amphoteracin B (need to monitor renal function
37
when to refer/admit gonorrhoea
conjunctival pregnant unresponsive to treatment ascending infection admit: disseminated, PID
38
treating diarrhoea in HIV
CMV: ganciclovir microsporidium: albendazole MAI: 12m anti TB cyclo/isospora: cotrimox salmonella/shigella: azithro HAART side effect: loperamide cryptosporidium: supportive
39
HIV 1 vs 2
1 is worldwide 2 is endemic to west africa
40
factors that increase risk of HIV transmission
concurrent STIs esp HSV-1 and other ulceratives hep C coinfection high viral load advanced stage of disease
41
seroconversion
development of persistent detectable antibody response to HIV
42
stages of HIV infection
infection clinical latency after seroconversion- progressive fall in CD4 and rise of viral load over 5-10y early and late AIDS
43
HIV diagnosis
serology for antibody- 3 month window between inoculation and seropositive test for HIV RNA and p24 in window also test for Hep B and C
44
HAART drugs
NRTI- zidovudine, lamivudine NNRTI- efavirenz, nevirapine protease inhib- ritonavir, darunavir, saquinavir integrase inhib- rategravir, elvitegravir
45
hookworm
helminth, lives in small intestine of host infects human host through skin as larvae in sand/soil contaminated with faeces > migrates to lungs and gut > cutaneous larvae migrans, GI symptoms incl bleeding, protein loss, SOB and wheeze ancylostoma duodenale necator americanus
46
leprosy treatment
dapsone + rifampicin + clofazimine
47
listeria treatment
generally supportive amox or cotrimox if immunosuppressed or pregnant or > 60y ampicillin + gent if meningitis or systemic infection
48
lyme disease organism
europe- borellia garinii, afzelii n america- borellia burgdorferi
49
lyme disease presentation stages
1 (localised): erythema migrans at bite site 1-4 weeks post bite fever, headache, regional lymphadenopathy 2: weeks to months post stage 1 myalgia, further rash, arthritis, neuro/cardiac 3 (chronic complications): months to years later oligoarthritis, neuro, acrodermatitis atrophicans
50
diagnosing lyme disease
IgM and IgG serology confirm positive ELISA with immunoblotting inflam markers will be normal in stage 2 and 3 if ELISA negative within 4 weeks, repeat if ELISA negative within 12 weeks, do immunoblot
51
jarisch herxheimer reaction
self limiting reaction to abx in lyme disease onset hours to days following start of abx
52
falciparum malaria treatment
uncomplicated- artemesinin tablets severe- IV artesunate or IV quinine then doxy
53
malaria associated with severe anaemia, AKI, splenic rupture
p vivax
54
causes of nec fasc
staph aureus strep clostridiu, perfringens
55
types of nec fasc
1- polymicrobial 2- group a strep 3- marine organisms 4- fungal
56
nec fasc risk factors
raised CRP, WBC raised creat, glucose low Hb, Na
57
focal vs generalised neuro disease in AIDS
focal: toxoplasmosis TB meningitis generalised: cryptococcal meningitis PML (JC virus) CMV encephalitis focal commonly presents w/ dysphagia, hemiparesis, seizures
58
diagnosing cryptococcal meningitis
CSF india ink serum cryptococcal antigen
59
toxoplasmosis treatment
pyrimethamine + sulfadiazine + folinic acid to prevent BM suppression
60
preventing peripheral neuropathy from isoniazid
pyridoxine
61
PID treatment
ceft + doxy + metro or oflox + metro or moxiflox
62
q fever
coxiella burnetti zoonotic > doxy > cotrimox 5/52 if pregnant
63
rocky mountain spotted fever
rickettsia rickettsii wrists > trunk > extremities may be eschar at bite site > doxy or chloramphenicol
64
qSOFA
quick sequential organ failure assessment SBP< 100 RR > 22 GCS < 15
64
schisto treatment
praziquantel 2 doses for haematobium, mansoni TDS for japonicum may need another dose a few weeks later
65
contact tracing for syphilis
primary: 3/12 secondary: 2y tertiary: > 2y
66
patterns of immunodeficiency
neutrophil: recurrent bacterial or fungal skin infections complement: often incidental, neisseria B cell: sinopulmonary T cell: opportunistic (PCP), invasive (CMV), intracellular (salmonella, mycobacteria)
67
abx for endocarditis
native valve: amox + gent prosthetic valve: vanc + gent + rifampicin staph: fluclox MRSA: vanc + rifamp strep: benpen +/- gent HACEK: amox + gent
68
endocarditis indications for surgery
cardiac failure or haemodynamic compromise extensive valve incompetence large veg emboli or abscess fungal abx resistant
69
abx for TSS
IV clinda + fluclox/vanc
70
typhoid fever
prolonged fever, abdo pain, rose spot rash s typhi and s paratyphi bacteria invade gut wall > migrate into peyers patches of distal ileum > spread throughout reticuloendothelial system >liver, spleen, BM, bloodstream asymptomatic until bacteraemic
71
typhoid fever stages
week 1: high fever, relative bradycardia disturbed bowel habit (constipation more common) nausea, prodromal week 2: persistent fever, rose spots diarrhoea, abdo pain, splenomegaly week 3: hepatomegaly, bowel perf, GI bleed, meningitis, haemolytic anaemia, acute cholecystitis, renal failure, myocarditis
72
diagnosing typhoid
blood cultures stool cultures bone marrow, rose spot cultures Widals agglutination test antibodies
73
typhoid fever treatment
confirmed: ciproflox extensively resistant: meropenem + azithromycin suspected: cephalosporin +/- azithromycin dex for neuro complications
74
toxoplasmosis treatment
pyrimethamine and sulfadiazine folinic acid and weekly FBC prophylaxis: trimethoprim + sulfamethoxazole spiramycin to prevent vertical transmission
75
features of severe malaria
Hb < 50 glucose < 2.2 pH < 7.3 lactate > 5
76
falciparum malaria treatment
uncomplicated: artemesinin PO severe: IV artesunate or IV quinine then doxy
77
trypanosomiasis treatment
1st stage: W African- pentamidine E African- suramin 2nd stage: W African- nifurtimox + eflornithine E African- melarsoprol chagas: benznidazole or nifurtimox
78
trypanosomiasis
African- tsetse fly W African: t brucei gambiense E Africa: t brucei rhodesiense S American- reduvid bugs t cruzi chagas disease develops after 10-20y
79
TB treatment
R+I 6 months (12 months if CNS) P+E 2 months add steroids for meningitis add 3 months if pyrazinamide is discontinued due to s/e RIP- hepatitis, risk increases with age E- optic neuritis, yellow vision I- peripheral neuropathy (give with pyridoxine) R= orange/red urine
80
opportunistic mycobacterial disease
m kanasii, xenopi, malmoense, avium intracellulare cause disease identical to TB, undistinguishable on smear usually underlying COPD, bronchiectasis, previous TB > rifampicin + ethambutol 9m-2y
81
UTI treatment in pregnancy
nitro 7/7 (avoid if at term) amox cefalexin
82

MRCP 2 (12 decks)

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