ID III

Question 1

What is Lyme disease caused by

Answer 1

Lyme disease is caused by the spirochaete Borrelia burgdorferi and is spread by ticks

Question 2

Early features of Lyme disease

Answer 2

Erythema migraines

Systemic features - headaches, lethargy, fever, arthralgia

Question 3

Features of erythema migrans

Answer 3

‘bulls-eye’ rash is typically at the site of the tick bite
typically develops 1-4 weeks after the initial bite but may present sooner
usually painless, more than 5 cm in diameter and slowlly increases in size

Question 4

Late features of Lyme disease

Answer 4

cardiovascular
heart block
peri/myocarditis

neurological
facial nerve palsy
radicular pain
meningitis

Question 5

Diagnosis of Lyme disease

Answer 5

Clinical if erythema migraines is present

Enzyme-linked immunoabsorbent assay(ELISA) antibodies to borrelia burgodorferi are - first line

Question 6

Mx of asymptomatic tick bites

Answer 6

if the tick is still present, the best way to remove it is using fine-tipped tweezers, grasping the tick as close to the skin as possible and pulling upwards firmly. The area should be washed following.

NICE guidance does not recommend routine antibiotic treatment to patients who’ve suffered a tick bite

Question 7

Mx of suspected/confirmed Lyme disease

Answer 7

Doxycycline if early disease - amoxicillin if contraindicated

Ceftriaxone if disseminated disease

Question 8

What is a Jarisch-herxheimer reaction

Answer 8

Jarisch-Herxheimer reaction is sometimes seen after initiating therapy: fever, rash, tachycardia after first dose of antibiotic (more commonly seen in syphilis, another spirochaetal disease)

Question 9

What type of bacterium is neisseria meningitidis

Answer 9

gram neg diplococcus

Question 10

Most common causes of bacterial meningitis in adults and children

Answer 10

Neisseria meningitidis (meningococcus) and Streptococcus pneumoniae (pneumococcus).

Question 11

Most common cause of bacterial meningitis in neonates

Answer 11

Group B strep (GBS)

Question 12

Tests to look for meningeal irritation in infants

Answer 12

Kernigs Test

Brudzinski’s Test

Question 13

Mx of bacterial meningitis in community

Answer 13

IM or IV benzylpenicillin

Question 14

Mx of bacterial meningitis in hospital

Answer 14

LP prior to antibiotics unless acutely unwell

Meningococcal PCR

Question 15

What can be added to management of bacterial meningitis

Answer 15

Steroids - dexamethasone to reduce the frequency and severity of hearing loss and neurological damage

Question 16

Post exposure prophylaxis for bacterial meningitis

Answer 16

Most likely within first 7 days

Ciprofloxacin

Question 17

Most common causes of viral meningitis

Answer 17

HSV
Enterovirus
VZV

Question 18

Mx of viral meningitis

Answer 18

Supportive

Aciclovir can be used to treat suspected or confirmed HSV meningitis.

Question 19

CSF - bacterial meningitis

Answer 19

Cloudy
High protein
Low glucose
Neutrophils

Question 20

CSF - viral meningitis

Answer 20

Clear
Mildly raised/normal protein
Normal glucose
Lymphocytes

Question 21

Complications of meningitis

Answer 21

Hearing loss 
Seizures/epilepsy
Cognitive impairment 
Memory loss 
Focal neurological deficits

Question 22

CSF - TB

Answer 22

Slightly cloudy
Low glucose(1/2 plasma)
High protein
Lymphocytes

Question 23

CSF - Fungal

Answer 23

Cloudy
Low glucose
High protein
Lymphocytes

Question 24

Most common cause of meningitis in >60 years

Answer 24

Strep pneumoniae

Question 25

Most common cause of meningitis in immunocompromised people

Answer 25

Listeria monocytogenes

Question 26

Causes of short-lived gastroenteritis(1-2 days)

Answer 26

Toxin-mediated - bacillus cereus, norovirus

Question 27

Causes of medium duration gastroenteritis

Answer 27

Salmonella
Shigella
E coli
Rotavirus

Question 28

Causes of longer duration gastroenteritis

Answer 28

Giardiasis
Campylobacter
C. diff

Question 29

4 C’s of measles

Answer 29

Cough
Coryza
Conjunctivitis
Koplik spots

Question 30

Risk factors for candidemia

Answer 30

Surgery 
Immunosuppressants(steroids) 
Central line 
TPN
Broad spectrum abs

Question 31

Causes of typhoid and paratyphoid fever

Answer 31

Salmonella typhi and Salmonella paratyphi (types A, B & C) respectively

Question 32

How is typhoid transmitted

Answer 32

Faecal-oral route

Contaminated food and water

Question 33

Features of enteric fever

Answer 33

Initial systemic upset 
Relative bradycardia 
Abdominal pain/distension 
Constipation 
Rose spots(trunk)

Question 34

Complications of enteric fever

Answer 34

Osteomyelitis
GI bleed/perf
Meningitis
Cholecystitis

Question 35

What is cellulitis typically due to

Answer 35

infection by Streptococcus pyogenes or Staphylcoccus aureus.

Question 36

Features of cellulitis

Answer 36

commonly occurs on the shins
erythema, pain, swelling
there may be some associated systemic upset such as fever

Question 37

Classification for how to manage cellulitis

Answer 37

Eron classification

Question 38

When should patients be admitted for IV abx in cellulitis

Answer 38

Eron class III or IV
Severe or rapidly deteriorating
Immunocompromised

Question 39

What is iron class III/IV

Answer 39

Significant systemic upset

Sepsis/severe life-threatening infection such as necrotising fasciitis

Question 40

1st line antibiotic for cellulitis

Answer 40

flucloxacillin as first-line treatment for mild/moderate cellulitis.

severe cellulitis should be offered co-amoxiclav, cefuroxime, clindamycin or ceftriaxone.