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General practice > ID II > Flashcards

ID II Flashcards

1
Q

What is kaposi’s sarcoma caused by

A

HHV-8(human herpes virus 8)

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2
Q

How does kaposi’s sarcoma present

A

Purple papules or plaques on the skin or mucosa

skin lesions may later ulcerate
respiratory involvement may cause massive haemoptysis and pleural effusion

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3
Q

What type of virus is HIV

A

RNA retrovirus

HIV-1 most common

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4
Q

Disease progression of HIV

A

An initial seroconversion flu-like illness occurs within a few weeks of infection.

The infection is then asymptomatic until it progresses and the patient becomes immunocompromised and develops AIDS-defining illnesses and opportunistic infections potentially years later.

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5
Q

Transmission of HIV

A

Unprotected anal, vaginal or oral sexual activity.

Mother to child at any stage of pregnancy, birth or breastfeeding. This is referred to as vertical transmission.

Mucous membrane, blood or open wound exposure to infected blood or bodily fluids such as through sharing needles, needle-stick injuries or blood splashed in an eye.

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6
Q

AIDS-defining illnesses associated with end-stage HIV

A 
Kaposi's sarcoma 
PCP
CMV
Candidiasis(oesophageal or bronchial) 
Lymphomas 
TB
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7
Q

How long can antibody tests be negative for following exposure to HIV

A

Antibody tests can be negative for 3 months following exposure so repeat testing is necessary

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8
Q

Testing for HIV

A

Antibody test

p24 antigen test(can give positive result earlier in infection in comparison with antibody test)

PCR testing for HIV RNA

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9
Q

normal CD4 range and abnormal range

A

500-1200 cells/mm3 is the normal range

Under 200 cells/mm3 is considered end stage HIV / AIDS and puts the patient at high risk of opportunistic infections

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10
Q

Treatment for HIV

A

Combination of antiretroviral therapy

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11
Q

Association between HIV and cardiovascular disease

A

HIV infection increases the risk of developing cardiovascular disease. Patients with HIV have close monitoring of cardiovascular risk factors and blood lipids and appropriate treatment (such as statins) to reduce their risk of developing cardiovascular disease.

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12
Q

Why is co-trimoxazole given to HIV patients with CD4<200/mm^3

A

Prophylactic co-trimoxazole (Septrin) is given to patients with CD4 < 200/mm3 to protect against pneumocystis jirovecii pneumonia (PCP).

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13
Q

Why are yearly cervical smears required for women with HIV

A

HIV predisposes to developing cervical human papillomavirus (HPV) infection and cervical cancer so female patients need close monitoring to ensure early detection of these complications.

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14
Q

Risk factors for HIV

A

Have a current or former partner who is infected with HIV.
Are from an area with high HIV prevalence
MSM
Transwomen
IVDU
Sex workers
Blood transfusions

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15
Q

Adverse effects of ART in HIV

A 
Hypersensitivity(fever,rash)
Mood changes 
Peripheral neuropathy 
Hyperlipidaemia 
T2DM
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16
Q

How quickly should PEPSE be initiated in a person with exposure to HIV

A

PEPSE can be initiated if the person presents within 72 hours of exposure and should be given as early as possible (ideally within 24 hours of exposure).

HIV testing is recommended 8–12 weeks after exposure.

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17
Q

Common causes of intra-abdominal infections

A 
Anaerobes (e.g. bacteroides and clostridium)
E. coli
Klebsiella
Enterococcus
Streptococcus
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18
Q

Co-amoxiclav cover

A

This provides good gram positive, gram negative and anaerobic cover. It does not cover pseudomonas or atypical bacteria.

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19
Q

Quinolones cover

A

Ciprofloxacin and levofloxacin provide reasonable gram positive and gram negative cover and also cover atypical bacteria however they don’t cover anaerobes so are usually paired with metronidazole when treating intra-abdominal infections.

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20
Q

Metronidazole cover

A

This provides exceptional anaerobic cover but does not provide any cover against aerobic bacteria.

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21
Q

Gentamicin cover

A

This provides very good gram negative cover with some gram positive cover particularly against staphylococcus.

It is bactericidal so works to kill the bacteria rather than just slowing it down.

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22
Q

Vancomycin cover

A

This provides very good gram positive cover including MRSA. It is often combined with gentamicin (to cover gram negatives) and metronidazole (to cover anaerobes) in patients with penicillin allergy.

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23
Q

Cephalosporins cover + why are they sometimes avoided

A

These provide good broad spectrum cover against gram positive and gram negative bacteria but are not very effective against anaerobes.

They are often avoided due to the risk of developing C. difficile infection.

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24
Q

Management of SBP

A

Piperacillin/Tazobactam (Tazocin) is often first line

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25
Q

Which patients often present with SBP

A

Patients with liver failure

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26
Q

Examples of gram-positive cocci

A

Staphylococcus
Streptococcus
Enterococcus

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27
Q

Examples of gram-positive rods

A

Use the mnemonic “corney Mike’s list of basic cars”:

Corney – Corneybacteria
Mike’s – Mycobacteria
List of – Listeria
Basic – Bacillus
Cars – Nocardia
28
Q

Examples of gram positive anaerobes

A

Use the mnemonic “CLAP”:

C – Clostridium
L – Lactobacillus
A – Actinomyces
P – Propionibacterium

29
Q

Antibiotic treatment options for MRSA

A

Doxycycline
Clindamycin
Vancomycin

30
Q

What are ESBLs

A

Extended Spectrum Beta Lactamase bacteria

bacteria that have developed resistance to beta-lactam antibiotics(e.coli or klebsiella)

31
Q

Management of ESBLs

A

Carbapenems

32
Q

Staining to identify TB

A

They require a special staining technique using the Zeihl-Neelsen stain.

33
Q

How does TB spread

A

It is mostly spread by inhaling saliva droplets from infected people.

It then spreads through the lymphatics and blood

34
Q

Active vs latent TB

A

Active TB is where there is active infection in various areas within the body. In the majority of cases the immune system is able to kill and clear the infection.

The immune system may encapsulate sites of infection and stop the progression of the disease and this is referred to as latent TB.

35
Q

What is secondary TB

A

When latent TB reactivates this is known as secondary TB

36
Q

Features of infected lymph nodes in TB

A

A “cold abscess” is a firm painless abscess caused by TB, usually in the neck. They do not have the inflammation, redness and pain you would expect from an acutely infected abscess.

37
Q

Risk factors for TB

A

Known contact with active TB
Immigrants from areas of high TB prevalence
People with relatives or close contacts from countries with a high rate of TB
Immunosuppression due to conditions like HIV or immunosuppressant medications
Homeless people, drug users or alcoholics

38
Q

What is the BCG vaccine

A

The BCG vaccine involves an intradermal infection of live attenuated (weakened) TB.

It offers protection against severe and complicated TB but is less effective at protecting against pulmonary TB.

39
Q

Tests prior to BCG vaccine

A

patients are tested with the Mantoux test and given the vaccine only if this test is negative. They are also assessed for the possibility of immunosuppression and HIV due to the risks related to a live vaccine.

40
Q

TB presentation

A 
Lethargy
Fever or night sweats
Weight loss
Cough with or without haemoptysis
Lymphadenopathy
Erythema nodosum
Spinal pain in spinal TB (also known as Pott’s disease of the spine)
41
Q

What is the Mantoux test used for

A

To look for a previous immune response to TB. This indicates possible previous vaccination, latent or active TB.

42
Q

What does the IGRA test involve

A

This test involves taking a sample of blood and mixing it with antigens from the TB bacteria.

In a person that has had previous contact with TB the white blood cells have become sensitised to those antigens and they will release interferon-gamma as part of an immune response.

If interferon-gamma is released from the white blood cells then this is considered a positive result.

43
Q

When is the IGRA test used

A

The IGRA test is used in patients that do not have features of active TB but do have a positive Mantoux test to confirm a diagnosis of latent TB.

44
Q

Management of latent TB

A

Otherwise healthy patients do not necessarily need treatment for latent TB.

Patients at risk of reactivation of latent TB can be treated with either:

Isoniazid and rifampicin for 3 months
Isoniazid for 6 months

45
Q

Management of acute pulmonary TB

A

R – Rifampicin for 6 months
I – Isoniazid for 6 months
P – Pyrazinamide for 2 months
E – Ethambutol for 2 months

46
Q

Notable side effect of isoniazid

A

Peripheral neuropathy

47
Q

What should be co-prescribed with TB meds

A

Pyridoxine(vitamin B6)

48
Q

What type of rooms are used for patients with active TB

A

Negative pressure rooms are used to prevent airborne spread. Negative pressure rooms have ventilation systems that actively remove air to prevent it spreading out on to the ward

49
Q

How is treatment different for extra pulmonary TB

A

Can include using corticosteroids

50
Q

Notable side effects of rifampicin

A

Can cause red/orange discolouration of secretions like urine and tears. It is a potent inducer of cytochrome P450 enzymes therefore reduces the effect of drugs metabolised by this system.

This is important for medications such as the contraceptive pill.

51
Q

Notable side effect of pyrazinamide

A

Pyrazinamide can cause hyperuricaemia (high uric acid levels) resulting in gout.

52
Q

Notable side effects of ethambutol

A

Ethambutol can cause colour blindness and reduced visual acuity.

53
Q

What type of virus is influenza

A

RNA virus

54
Q

Presentation of influenza

A 
Fever
Coryzal symptoms
Lethargy and fatigue
Anorexia (loss of appetite)
Muscle and joint aches
Headache
Dry cough
Sore throat
55
Q

Diagnosis of influenza

A

Viral nasal or throat swabs can be sent to the local virology lab for polymerase chain reaction (PCR) analysis.

56
Q

General management of influenza

A

Healthy patients that are not at risk of complications do not need treatment with antiviral medications. The infection will resolve with self care measures such as adequate fluid intake and rest.

57
Q

Antiviral options for influenza

A

Oral oseltamivir 75mg twice daily for 5 days

Inhaled zanamivir 10mg twice daily for 5 days

Within 48hrs of onset of symptoms to be effective

58
Q

Complications of influenza

A 
Otitis media, sinusitis and bronchitis
Viral pneumonia
Secondary bacteria pneumonia
Worsening of chronic health conditions such as COPD and heart failure
Febrile convulsions (young children)
Encephalitis
59
Q

Dengue fever aetiology

A

dengue virus is a RNA virus of the genus Flavivirus

transmitted by theAedes aegyptimosquito

60
Q

Dengue fever clinical features

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

61
Q

Dengue fever warning signs

A

abdominal pain

hepatomegaly

persistent vomiting

clinical fluid accumulation (ascites, pleural effusion)

62
Q

Features of severe dengue fever

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)

63
Q

Typical blood results in dengue fever

A

leukopenia, thrombocytopenia, raised aminotransferases

64
Q

Dengue fever diagnosis

A

serology

nucleic acid amplification tests for viral RNA

NS1 antigen test

65
Q

Dengue fever mx

A

entirely symptomatic e.g. fluid resuscitation, blood transfusion etc

no antivirals are currently available

General practice (26 decks)

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