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Infection Flashcards

1
Q

If someone has a positive HBsAg (Hep B surface antigen), what does this indicate regarding Hep B infection?

A

They currently have an active infection

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2
Q

What are the aims of HIV treatment?

What does HIV treatment involve?
~ when is it started?

A

Aims of treatment:
• normal CD4 count
​• undetectable viral load

HIV treatment: cART
Treatment involves a combination of 3 of the below:
​• Protease inhibitors
​• Integrase inhibitors
​• Nucleoside reverse transcriptase inhibitors (NRTIs)
​• NNRTIs
~ treatment is started as soon as infection is confirmed regardless of their CD4/ viral load count!

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3
Q

If an infection isnt resolving, despite adequate treatment, what condition should you investigate for?

A

HIV

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4
Q

Explain the routes of transmission of each type of viral hepatitis:

A

A - faecal-oral route

B - bodily fluids / vertical transmission (mother-baby)

C - bodily fluids

  • *D -** bodily fluids
  • *** can only survive in patients who also have a Hep B infection ****

E - faecal-oral route

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5
Q

Name 4 antibiotics that are associated with C.difficile infection after their use:
C’s….

A

• Co-amoxiclav

  • Cephalosporins (eg, ceftriaxone)
  • Clindamycin
  • Ciprofloxacin
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6
Q

What antibiotic is 1st line to treat the first episode (presentation) of a clostridium difficile infection?

If C. diff returns post treatment, what antibiotic is recommended to treat the recurring infection?

A

10 days of oral Vancomycin

Oral fidaxomicin

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7
Q

What group of bacteria are the commonest (70%) cause of cellulitis?

What is the 1st line antibiotic to treat cellulitis because of the above bacteria?

IF the cellulitis is _hospital acquired_ (eg, from a cannula), what is the most likely causative organism then???

A
  • *Streptococcus**
  • (Staphlococci = 30%)*

1st line antibiotic: Flucloxacillin

Hospital acquired: Staph aureus (commonly MRSA!!)

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8
Q

What cells does HIV destroy?

What are the 3 ways that HIV can be tested for in someone?

What 2 things are used to monitor a HIV infection? (below what num. would be abnormal/ end stage disease?)

A

CD4 T helper cells

1) Antibody blood test - may appear negative until 3 months post exposure
2) PCR: p24 antigen - detects the HIV antigen in the blood
2) PCR: HIV RNA - detects the quantitiy of HIV in the blood (used to measure viral load)

Monitoring:
1) CD4 count
~ below 500 cells/mm3 = abnormal (deficient)
~ below 200 cells/mm3 = end stage disease (AIDs)
2) Viral load

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9
Q

What investigation is essential in order to diagnose meningitis in children?
~ What would be an absolute contraindictation to this?

A

Lumbar puncture
~ signs of raised ICP

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10
Q

In terms of blood results, viral hepatitis and autoimmune hepatitis will cause a raised AST & ALT +/- bilirubin. What other blood results allow you to distinguish between a viral or autoimmune cause of hepatitis?

A

Autoimmune hepatitis will always ha a raised IgG but a viral cause won’t.

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11
Q

Name the commonest 1. bacterial and 2 viral causative organisms of tonsillitis:

What would be the treatment of tonsillitis if it is caused by:

  • *1. bacteria
    2. virus**
A

Bacterial: strep throat = penicillin

Viral: epstein barr virus (aka, glandular fever) = supportive (analgesia & fluids)

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12
Q

What scoring system is used to assess the severity of a pneumonia?

A

CURB-65

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13
Q

What are the 6 components of sepsis 6?
~ state the order you would do these in

(take 3, give 3)

A

1) Give O2 if sats are below 94%
2) Take blood cultures
3) Give IV antibiotics
4) Fluid challenge (give IV fluids)
5) Measure blood lactate
6) Measure urine output

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14
Q

What bacteria is the commonest cause of a community acquired pneumonia?

What is the 1st line antibiotic used to treat a mild/moderate CAP? (if the patient has no allergies)

A

Strep pneumoniae

Oral amoxicillin

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15
Q

Which inflammatory marker would you expect to be elevated on a FBC if there is a:

  1. Bacterial cause of infection
  2. Viral cause of infection
A
  • Bacterial:* Raised neutrophils
  • Viral:* Raised lymphocytes
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16
Q

What are the 6 components of sepsis 6?
~ state the order you would do these in

(take 3, give 3)

A

1) Give O2 if sats are below 94%
2) Take blood cultures
3) Give IV antibiotics
4) Fluid challenge (give IV fluids)
5) Measure blood lactate
6) Measure urine output

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17
Q

If a pregnant woman is HIV positive, is she able to have a normal vaginal delivery?

If a pregnant woman is HIV positive, is she able to breastfeed?

What prophylaxis treatment is given to all babies born to HIV+ women?

A

Vaginal delivery: ONLY if her viral load is undetectable (< 50 copies/ ml) - otherwise C-section recommended

Breastfeeding: NO. Even if viral load is undetectable, HIV can be transmitted to baby through the breast milk!

Prophylaxis:
• Viral load is undetectable (< 50 copies/ ml) = 1x antiviral for 4 weeks
• Viral load is detectable (> 50 copies/ ml) = 3x antiviral for 4 weeks

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18
Q

Regarding Hepatitis B infection, what do the following biochemical markers mean/ indicate:

  1. HBsAg (Hep B surface antigen)
  2. HBeAg (Hep B E antigen)
  3. HBcAb (Hep B core antibodies)
    ~ IgM
    ~ IgG
  4. HBsAb (Hep B surface antibodies)
  5. HBV DNA (Hep B virus DNA)
A

1. HBsAg - indicates an active infection

2. HBeAg - marker of viral infection (so the acute phase of the disease when the virus is actively replicating)
~ the higher the HBeAg, the more infectious the person is ~

3. HBcAb - indicates a past or current infection
~ IgM version of HBcAb = active infection
~ IgG version of HBcAb = past infection (HBsAg will be negative)

4. HBsAb - indicates vaccination / past/ current infection

5. HBV DNA - viral load

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19
Q

To be classed as having neutropenic sepsis, the patient needs to have sepsis and a neutrophil count of what?

Name some medications that can cause neutropenia: (6)

A

Less than 1x109/L

  • Chemotherapy drugs
  • Clozapine (schizophrenia)
  • Carbimazole (hyperthyroidism)
  • Methotrexate (RA)
  • Sulfasalazine (RA)
  • Hydroxychloroquine (RA)
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20
Q

Name the antibiotic of choice for treating neutropenic sepsis:

A

Tazocin

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21
Q

What bacteria is the commonest cause of a community acquired pneumonia in:
1. healthy patients

  1. patients with cystic fibrosis (2)
A
  1. Strep pneumoniae
  2. CF: staph aureus/ pseudomonas aeruginosa
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22
Q

What bacteria is the commonest cause of a UTI?

~ is this a gram positive or gram negative bacteria?

A

E.coli

~ gram negative

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23
Q

Which 2 antibiotics are commonly used in the treatment of a lower UTI?

~ State which one is used 1st and 2nd line

Which of the above is commonly used in pregnancy?
~ when is it safe to use in pregnancy? (eg, which trimesters)

What medication is used in the remaining trimester of pregnancy when the above medication is no longer suitable?

A

1st line: trimethoprim

2nd line: nitrofurantoin
~ 1st & 2nd trimesters of pregnancy

Amoxicillin
~ used in 3rd trimester of pregnancy

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24
Q

Which antibiotic is used 1st line for the treatment of a lower UTI?

State the duration of antibiotic treatment of lower UTI in the following:
1. healthy women

  1. women that are immunosuppressed/ impaired kidney function
  2. men, pregnancy, catheter related UTI’s
A

1st line: trimethoprim

1. healthy women: 3 days

2. women that are immunosuppressed/ impaired kidney function: 5-10 days

3. men, pregnancy, catheter related UTI’s: 7 days

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25
Q

Why is nitrofurantoin avoided in the 3rd trimester of pregnancy?

Why is trimethoprim avoided in the 1st & 2nd trimesters of pregnancy?

A

Nitrofurantoin: it can cause haemolytic anaemia in the newborn

Trimethoprim: it works by inhibiting folate production & fetus’s need folate (folate deficiency can cause neural tube defects)

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26
Q

If cellulitis has a golden-yellow crust, which bacteria does this indicate as the cause of infection?

A

Staph aureus

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27
Q

What is the commonest bacteria that causes cellulitis?

Name the 2nd commonest bacterial cause of cellulitis:

A

1: Staph aureus
2: Strep pyogenes (group A strep)

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28
Q

Name the commonest bacterial cause of cellulitis:

Which classification system is used to assess the severity of cellulitis?

~ patient’s in which class would require an admission to hospital?

Name the 1st line antibiotic used to treat cellulitis:

A

Staph aureus

**Eron classification** (class 1 - 4)
~ class 3 & 4 would require admission

Flucloxacillin

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29
Q

Name the commonest bacterial cause of tonsillitis:

~ what is the 2nd commonest cause?

What is the management of a bacterial tonsillitis?

A

Group A strep (strep pyogenes)

~ 2nd commonest: strep pneumoniae

Penicillin V

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30
Q

What is the management of a viral cause of tonsillitis?

What is the management of a bacterial cause of tonsillitis? (what if there is a penicillin allergy?)

A

Viral: simple analgesia for pain & fever control (paracetamol & ibuprofen) + worsening advice

Bacterial: Penicillin V for 10 days

Penicillin allergy: clarithromycin for 10 days

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31
Q

The commonest cause of tonsillitis is viral > bacterial.

Which 2 criteria are used to estimate the probability that tonsillitis is due to a bacterial infection?

~ list the features within each criteria

~ state the score needed in each criteria to consider prescribing antibiotics

A

CENTOR: score of 3+

Fever over 38 degrees

Tonsillar exudates

NO cough

Tender anterior cervical lymph nodes

Fever PAIN: score of 4+

Fever

Purulent exudate

Attended within 3 days of the onset of symptoms

Inflamed tonsils

No cough/coryzal symptoms

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32
Q

What is otitis media?

What is the management of otitis media?

~ how long does it usually take to resolve?

If the infection fails to resolve with the above management, what would the next step in management be?

A

Infection of the middle ear

Supportive management (ibuprofen/ paracetamol)

~ usually resolves within 3-7 days

Prescribe amoxicillin if supportive management fails

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33
Q

Sinusitis can be bacterial or viral but commonly self-resolves without treatment.

How long does sinusitis usually last for before it self resolves?

What is the management of sinusitis according to the NICE guidelines:

  1. symptoms less than 10 days
  2. no improvement of symptoms after 10 days
  3. no improvement of symptoms after 10 days & likely a bacterial cause
A

2-3 weeks

Management:

  1. symptoms less than 10 days
    ~ supportive treatment (no antibiotics)
  2. no improvement of symptoms after 10 days

~ 2 weeks of high dose steroid nasal spray

  1. no improvement of symptoms after 10 days & likely a bacterial cause

~ penicillin V for 5 days

~ clarithromycin if allergic

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34
Q

Which joint is the commonest joint to be affected by septic arthritis?

Name the commonest organism to cause septic arthritis:

~ what would be the likely organism in sexually active people?

Which investigation is required in suspected septic arthritis to make a definitive diagnosis?

A

KNEE

Staph aureus

~ neisseria gonorrhoea

Joint aspirate → gram staining, crystal microscopy, culture & antibiotic sensitivities

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35
Q

Name the 2 commonest causes of viral gastroenteritis in the UK:

What are the typical symptoms of gastroenteritis? (3)

A
  • Rotavirus
  • Norovirus

Symptoms:
~ Nausea
~ Vomiting
~ Diarrhoea

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36
Q

E.coli is a cause of gastroenteritis. By which route is E.coli spread?

The Shiga toxin is produced by which strain of E.coli?

What symptoms does this strain of E.coli produce? (3)

What complication is associated with the Shiga toxin?

A

Faecal-oral transmission

E.coli 0157
~ abdominal cramps
~ bloody diarrhoea
~ vomiting

Haemolytic uraemic syndrome

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37
Q

Campylobacter jejuni is a common cause of travellers diarrhoea. By which ways can the bacteria be spread? (3)

What are the symptoms of a campylobacter infection? (4)

A

Transmission:

  • raw/ undercooked chicken
  • dirty water
  • unpasteurised milk

Symptoms:

  • abdominal cramps
  • diarrhoea +/- blood
  • vomiting
  • fever
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38
Q

Shigella is a cause of gastroenteritis. By which route is the bacteria spread?

What are the symptoms of a shigella infection? (3)

What toxin can shigella produce?

~ what complication is associated with this toxin?

A

Faecal-oral route
~ usually faeces contaminating food/water/swimming pools

Symptoms:

  • abdominal cramps
  • blood diarrhoea
  • fever

Shiga toxin

~ haemolytic uraemic syndrome

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39
Q

Salmonella is a cause of gastroenteritis. By which ways can the bacteria be spread? (2)

What are the symptoms of a salmonella infection? (3)

A
  • Eating raw eggs/ poultry (chicken)
  • Food contaminated with infected faeces

Symptoms:

  • watery diarrhoea +/- mucus/blood
  • abdominal pain
  • vomiting
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40
Q

Bacillus cereus is a gram positive rod that can cause gastroenteritis. How is this bacteria spread?

~ In an SBA, what food would indicate this infection?

What are the symptoms associated with this infection? (3)

How long does it usually take for symptoms to resolve?

A

Spread through inadequately cooked food.
~ EXAMS: fried rice left out at room temperature

Symptoms:

  • abdominal cramps (after 5h of ingestion)
  • vomiting (after 5h of ingestion)
  • watery diarrhoea (after 8h of ingestion)

Symptoms resolve within 24hours

41
Q

Giardiasis lamblia is a parasite that causes gastroenteritis. What is the route of transmission of this parasite?

Infection doesn’t always cause symptoms, however if it does, what is the symptom that it causes?

What is the treatment of this infection?

A

Faecal-oral transmission
~ commonly from animals, eg pets/ farmyards

Symptom: chronic diarrhoea

Metronidazole

42
Q

Name the 2 commonest bacterial causes of meningitis in adults & children:

Name the commonest cause of bacterial meningitis in neonates:

A

Adults & children:
~ neisseria meningitidis
~ strep pneumoniae

Neonates:
~ group B strep

43
Q

List the typical symptoms of a meningitis infection: (7)

If the meningococcus bacteria enter the bloodstream, what condition does this cause?

~ what other symptom would you see in this condition?

A
  • neck stiffness
  • fever
  • vomiting
  • headache
  • photophobia
  • altered consciousness
  • seizures

Meningococcal septicaemia
~ non-blanching rash

44
Q

If you’re working in GP and you see a child with suspected meningitis + a non-blanching rash, how should you manage them? (2)

Which investigations should be performed if someone presents to hospital with suspected meningitis? (3)

A
  1. IM/ IV benzylpenicillin stat
  2. immediate transfer to hospital
  • Blood cultures
  • lumbar puncture (for CSF)
  • meningococcal PCR (this looks for meningococcal DNA)
45
Q

Bacterial meningitis is treated with an antibiotic regime ASAP. What other medication should be given to children >3 months?

~ why is this medication given?

A

Steroids (dexamethasone)

~ reduces the severity of hearing loss & neurological damage

46
Q

Name the 3 commonest causes of viral meningitis:

If meningitis is suspected, what investigation should be performed?

A
  • Herpes simplex virus
  • Enterovirus (usually causes flu-like symptoms)
  • Varicella zoster virus

Lumbar puncture

47
Q

You have the lumbar puncture results from a patient with suspected meningitis. From these results determine whether the likely cause is bacterial or viral:
~ explain why you think this

Appearance of CSF: cloudy

Protein: 3.2g/L (normal = 0.2-0.4g/L)

Glucose: 0.2 (normal = 0.6-0.8)

WCC: 2400, neutrophils present

A

Bacterial meningitis

~ CSF is cloudy
~ high protein, low glucose (bacteria use the glucose and produce protein)

~ neutrophils are produced in response to a bacterial infection

48
Q

You have the lumbar puncture results from a patient with suspected meningitis. From these results determine whether the likely cause is bacterial or viral:
~ explain why you think this

Appearance of CSF: clear

Protein: 0.45g/L (normal = 0.2-0.4g/L)

Glucose: 0.6 (normal = 0.6-0.8)

WCC: 1800, lympocytes present

A

Viral meningitis

~ CSF is clear

~ lymphocytes are produced in response to a viral infection

49
Q

The immune system releases neutrophils in response to what type of infection? (bacterial/ viral)

The immune system releases lymphocytes in response to what type of infection? (bacterial/ viral)

A

Neutrophils = bacterial

Lymphocytes = viral

50
Q

What is the commonest long-term complication associated with meningitis infection?

A

Hearing loss

51
Q

TB usually presents with chronic, slowly progressive symptoms. List some: (6)

What is the management of acute TB? (RIPE)
~ state the common side effects

A
  • Cough +/- haemoptysis
  • Fever/ night sweats
  • Weight loss
  • Fatigue
  • Erythema nodosum (nodules on shins)
  • Lymphaddenopathy

Management of acute TB:

R: Rifampicin (6 months)
S/E: red/ orange tears/ urine (secretions)

I: Isoniazid (6 months)
S/E: peripheral neuropathy

P: Pyrazinamide (2 months)
S/E: gout (causes high uric acid levels!)

E: Ethambutol (2 months)
S/E: colour blindness

52
Q

TB usually presents with chronic, slowly progressive symptoms. List some: (6)

What is the management of acute TB? (RIPE)
~ state how long each medication should be taken for

A
  • Cough +/- haemoptysis
  • Fever/ night sweats
  • Weight loss
  • Fatigue
  • Erythema nodosum (nodules on shins)
  • Lymphadenopathy

Management of acute TB:

R: Rifampicin (6 months)

I: Isoniazid (6 months)

P: Pyrazinamide (2 months)

E: Ethambutol (2 months)

53
Q

What is the management of acute TB? (RIPE)
~ state the common side effects

A

R: Rifampicin (6 months)
S/E: red/ orange tears/ urine (secretions)

I: Isoniazid (6 months)
S/E: peripheral neuropathy

P: Pyrazinamide (2 months)
S/E: gout (causes high uric acid levels!)

E: Ethambutol (2 months)
S/E: colour blindness

54
Q

What condition does the statement below indicate?

Sputum culture from a patient with a persistent cough grows acid-fast bacilli that stain red with Zeihl-Neelsen staining

A

TB

55
Q

If TB is suspected, which staining would be required from the list below?

  1. Gram staining
  2. Zeihl-neelsen staining
  3. Flagella staining
  4. Anaerobic staining

What colour would the bacteria stain on the above staining?

A

Zeihl-neelsen staining

~ RED

56
Q

What type of vaccine is the TB vaccine?

What must someone have done prior to being allowed the TB vaccine?

A

Live, attenuated vaccine

Mantoux test (to see if they have had a previous infection)

57
Q

What condition does this xray show? (be specific)

What is this condition?

A

Disseminated miliary TB

TB infection that the immune system is unable to control (and thus it spreads everywhereeeeee)

58
Q

What condition does this xray show? (be specific)

What features can you see on this xray/ would you expect to see on an xray of someone with this condition? (3)

A

Primary TB

  • patchy consolidation
  • hilar lymphadenopahy
  • pleural effusions
59
Q

What is the management of acute TB? (RIPE)
~ state the common side effects

A

R: Rifampicin (6 months)
S/E: red/ orange tears/ urine (secretions)

I: Isoniazid (6 months)
S/E: peripheral neuropathy

P: Pyrazinamide (2 months)
S/E: gout (causes high uric acid levels!)

E: Ethambutol (2 months)
S/E: colour blindness

60
Q

There are 4 different types/stages of TB infection, name them and describe what each type is:

A

Active TB - current, active infection

Latent TB - immune system manages to encapsulate the infection and thus stop progression of the disease

Secondary TB - reactivation of latent TB (reactivation of a previous TB infection!)

Disseminated miliary TB - occurs when the immune system is unable to control the infection and thus it spreads everywhere

61
Q

Name the 3 sample types that can be acquired for TB cultures:

A
  • Sputum
  • Blood cultures
  • Lymph node aspiration/ biopsy
62
Q

A healthy patient is found to have latent TB on routine testing, what treatment would they require?

A

No treatment needed.

Only patients at risk of reactivation (secondary TB) (eg immunocompromised) are treated

63
Q

A patient undergoing HIV anti-viral therapy is found to have latent TB on routine testing, what treatment would they require?

A

This patient is immunocompromised so is at high risk of reactivation of TB (secondary TB), and thus would require treatment.

Treatment is either:

  • Isoniazid for 6 months
    OR
  • Isoniazid + rifampicin for 3 months
64
Q

Isoniazid is a medication used in the management of acute TB infection.

Name the common side effect associated with this medication:

What additional medication is commonly prescribed alongside isoniazid to help prevent this side effect?

A

Isoniazid ~ peripheral neuropathy

Pyridoxine (vitamin B6) helps reduce peripheral neuropathy

65
Q

How long after initiating treatment should patients with active TB be isolated for?

A

2 weeks

66
Q

Rifampicin is a medication used in the management of acute TB infection.

Name the commonest side effect associated with rifampicin:

Rifampicin can also reduce the effectiveness of other medications. Which medication in-particular should you let patients know about? (eg, females)

A

Rifampicin ~ red/ orange secretions (urine/tears)

COCP effect is reduced by rifampicin

67
Q

A patient recently started on treatment for TB. Since starting treatment, they’ve noticed unusual sensations in their fingertips and feet.

Which medication is most likely to be implicated?

A

Isoniazide

68
Q

A patient recently started on treatment for TB. Since starting treatment, they’ve noticed a numb sensation in their legs and feet.

Which medication is most likely to be implicated?

A

Isoniazide

69
Q

A patient recently started on treatment for TB. Since starting treatment, they’ve noticed that their urine is bright orange.

Which medication is most likely to be implicated?

A

Rifampicin

70
Q

A patient recently started on treatment for TB. Since starting treatment, they’ve noticed difficulty recognising colours.

Which medication is most likely to be implicated?

A

Ethambutol

71
Q

A patient recently started on treatment for TB. Since starting treatment, they’ve noticed that the base of their big toe has become hot, swollen and painful.

What acute condition has this patient presented with?

Which medication is most likely to be implicated?

A

Pyrazinamide

72
Q

A patient recently started on treatment for TB. Since starting treatment, they’ve noticed pain in their fingers.

O/E you note gouty tophi appearing in the DIP joints.

Which medication is most likely to be impliacted?

A

Pyrazinamide

73
Q

Pneumocystitis jirovecii pneumonia (PCP) is an opportunistic infection associated with which condition?

What medication is given as prophylaxis to patients with the above condition to protect against this infection?

A

AIDS (end stage HIV)

Co-trimoxazole

74
Q

What is the range of a normal CD4 count?

A

500-1200 cells/mm3

75
Q

End stage HIV/AIDS is defined as a CD4 count below what?

A

200 cells/mm3

76
Q

What prophylaxis is given to ALL babies born to HIV+ve mothers?

A

Prophylaxis:
• Viral load is undetectable (< 50 copies/ ml) = 1x antiviral for 4 weeks (ART)
• Viral load is detectable (> 50 copies/ ml) = 3x antiviral for 4 weeks (cART)

77
Q

The plasmodium family of protozoan parasites cause what infection?

A

MALARIA

78
Q

Malaria is spread through bites from what type of creature? (be specific)

A

Female anopheles mosquitoes

79
Q

From the options below, which type of plasmodium causes the most severe type of malaria?

  1. Plasmodium ovale
  2. Plasmodium malariae
  3. Plasmodium falciparum
  4. Plasmodium vivax
A

Plasmodium falciparum

80
Q

From the options below, which type of plasmodium is the commonest cause of malaria in the UK?

  1. Plasmodium ovale
  2. Plasmodium malariae
  3. Plasmodium falciparum
  4. Plasmodium vivax
A

Plasmodium falciparum

81
Q

What are the 3 signs that you’ll commonly see if someone has malaria?

A
  • Pallor (due to anaemia)
  • Jaundice (high bilirubin due to the haemolytic anaemia)
  • Hepatosplenomegaly
82
Q

If someone is presenting with features of malaria, what investigation should you do to confirm the diagnosis?

A

Blood film (malaria blood film)

83
Q

A malaria blood film is required for a diagnosis of malaria. How many samples are needed to exclude a diagnosis of malaria?
~ what timeframe should these be taken at?

Why is this?

A

3 samples are required over 3 consecutive days

Malaria has a 48h cycle of maturation in RBC until they rupture and malaria is released back into the blood - 3 samples over 3 days means that at least 1 sample will detect malaria!

84
Q

Which of the below antimalarials is associated with sunburn & rash associated with sun exposure:

  1. malarone
  2. mefloquine
  3. doxycycline
A

Doxycycline

85
Q

What is the classical finding of secondary (reactivated) TB on a chest xray?

A

UPPER LOBE consolidation (with cavitation = gas filled spaces)

86
Q

What is the treatment of trichomonas vaginalis?

A

Oral metronidazole for 5-7 days

87
Q

What is the gold-standard investigation for assessing drug sensitivities in TB?

A

Sputum culture

88
Q

A 20y/o woman comes in for review as 4 weeks ago she had acute cystitis and was treated with no complications. Urine culture showed no resistant or atypical organisms. She has a history of recurrent lower UTIs and is frustrated as she had 6 in the last year, which has strained her new relationship. She tried cranberry juice and probiotics without benefit.

An ultrasound you arranged of her abdomen revealed no abnormality. Her post-void volume was 25 ml.

You review her behavioural and self-hygiene measures and find the only identifiable trigger is sexual intercourse.

What is the next best action?

A

Prescribe prophylactic antibiotics to be taken alongside sexual intercourse (single-dose use)

89
Q

An untreated rabies infection is usually always fatal.

What is the management following an animal bite in an at-risk country in:

  1. patient’s with previous rabies immunisation
  2. patient’s without previous rabies immunisation
A
  1. With previous rabies immunisation
    ~ wash the wound
    ~ give 2 further doses of rabies vaccine
  2. Without previous rabies immunisation
    ~ wash the wound
    ~ give human rabies immunoglobulin + full course of vaccination
90
Q

A 24y/o recent immigrant from Albania presents to ED with fever, headache and malaise. Over the past 24 hours he has also developed bilateral pain and swelling at the angle of the jaw, which is made worse by talking or chewing. O/E: his pulse is 90/min, temperature 38.4ºC and bilateral palpable, tender parotid glands.

What is the most likely diagnosis?

What is the management of this condition?

A

Mumps

Rest & analgesia (paracetamol for fever)
~ notifiable disease!!!

91
Q

Name the 2 first line treatments of genital warts:
~ state when each treatment would be used

A
  • Topical podophyllum (topical antiviral)
    ~ for multiple, non-keratinised warts
  • Cryotherapy
    ~ for single, keratinised warts
92
Q

Toxic shock syndrome is caused by which group of bacteria?

What rash is associated with this condition?

A

Staphylococcus

Widespread erythematous rash with desquamation (the rash (affected skin) starts to peel off)

93
Q

Which class of antibiotics can cause a black, hairy tongue?

Name an example of an antibiotic in this class:

A

Tetracycyclines

Eg, doxycycline

94
Q

People who have been exposed to a patient with confirmed bacterial meningitis should be given prophylactic antibiotics. Which antibiotic is used 1st line?

A

Ciprofloxacin

95
Q

If you see ‘acid-fast bacilli’ in a question, what condition should you be thinking of?

A

TB

96
Q

A 28y/o woman presents to the GP 2 weeks after returning from a holiday kayaking in a lake.
She reports feeling exhausted as she has been having ongoing fatty diarrhoea with abdominal pain, bloating and flatulence, all of which started while abroad, which appear worse when she takes any dairy.

What is the most likely cause of her presentation?

What is the biggest risk factor for contracting this condition?

What is the treatment of this condition?

A

Giardiasis infection (Giardia lamblia)

Swimming/drinking water from a lake/river

Treatment: metronidazole

97
Q

A classical finding of secondary TB on a chest xray is upper lobe consolidation with cavitation (gas filled spaces).

What organism is known to colonise these gas filled spaces?

What is the classical sign seen on a chest xray that would indicate colonisation by this organism?

A

Aspergillus fumigatus → forms an aspergilloma (a ball of fungus)

Crescent sign is seen on a chest xray

98
Q

Which STI is caused by Treponema pallidum?

A

Syphilis

99
Q

Name the 2 features of a primary syphilis infection:

How is syphilis transmitted?

What is the 1st line treatment of primary syphilis?

A
  • Local, non-tender lymphadenopathy
  • Chancre (a painless ulcer at the site of sexual contact)

Through sexual intercourse

A single dose of IM benzathine benzylpenicillin

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