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Year 6 > Infection > Flashcards

Infection Flashcards

1
Q

distinctive feature of PCP pneumonia

A

exercised induced oxygen desaturation

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2
Q

treatment for severe PCP pneumonia

A

IV pentamidine

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3
Q

what investigation is done to demonstrate the presence of Pneumocystitis jirovecii

A

bronchoalveolar lavage (BAL) and silver staining

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4
Q

which infections are associated with a vaginal pH >4.5

A

trichomonas vaginalis
bacterial vaginosis

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5
Q

which infection has yellow/green vaginal discharge

A

trichomanos vaginalis

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6
Q

treatment for trichomonas vaginalis

A

oral metronidazole for 5-7 days

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7
Q

microscopy finding in trichomonas vaginalis

A

microscopy of a wet mount shows motile trophozoites

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8
Q

which infection is characterised by a strawberry cervix

A

trichomonas vaginalis

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9
Q

What is Weil’s syndrome in leptospirosis infection?

A

The immune phase that occurs 5-7 days later when antibodies against the organism start to develop.

During the immune phase, patients may present with multisystem involvement such as renal failure, hepatic dysfunction, pulmonary haemorrhage and myocarditis with arrhythmias

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10
Q

When do antibodies test positive in Leptospirosis infection

A

after day 7

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11
Q

vector of leptospirosis

A

infected rat urine

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12
Q

main investigation for leptospirosis

A

serology for AB

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13
Q

management of leptospirosis

A

high-dose benzylpenicillin or doxycycline

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14
Q

what type of microbe is leptospira interrograns

A

spirochaete

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15
Q

when should prophylactic treatment for PCP pneumonia begin?

A

when CD4 count is below 200

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16
Q

How is MRSA from a carrier suppressed [2]

A

nose: mupirocin 2% in white soft paraffin, tds for 5 days

skin: chlorhexidine gluconate, od for 5 days

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17
Q

3 Abx used in MRSA treatment

A

vancomycin
teicoplanin
linezolid

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18
Q

What is the most effective single step to reduce the incidence of MRSA?

A

hand hygiene

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19
Q

what does the combined HIV test test for?

A

Ab against HIV and the p24 antigen

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20
Q

when must PEP be started after UPSI with an HIV carrier

A

within 72 hours

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21
Q

when should asymptomatic patients with HIV be tested?

A

4 weeks from exposure

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22
Q

what is the gold standard for diagnosing HIV

A

combined test

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23
Q

prophylaxis for contacts of patients with meningococcal meningitis [2]

how many doses?

A

oral ciprofloxacin or rifampicin now

single dose to all contacts in the 7 days to onset of symptoms, regardless of vaccination status

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24
Q

Abx for bacterial meningitis for patients aged 3 months to 50 years

A

IV cefotaxime or ceftriaxone

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25
Q

Abx for bacterial meningitis for patients aged >50

A

cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin)

to cover for Listeria

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26
Q

indicated for delayed LP in meningitis investigation [4]

A

1) signs of severe sepsis or a rapidly evolving rash
2) severe respiratory/cardiac compromise
3) significant bleeding risk
4) signs of raised intracranial pressure:
- focal neurological signs
- papilloedema
- continuous or uncontrolled seizures
- GCS ≤ 12

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27
Q

Abx for meningococcal meningitis

A

Intravenous benzylpenicillin or cefotaxime (or ceftriaxone)

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28
Q

Pneumonia with lymphopenia, hyponatraemia & deranged LFTs

A

Legionella

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29
Q

Pneumonia associated with erythema multiforme (target)

A

mycoplasma

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30
Q

Pneumonia associated with red currant jelly sputum

A

Klebsiella

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31
Q

Pneumonia associated with rusty coloured sputum

A

Strep pneumo

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32
Q

diagnostic test for Legionella

A

urinary antigen

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33
Q

treatment for legionella

A

erythromycin/clarithromycin

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34
Q

which infection is a risk factor for hepatocellular carcinoma

A

Hep B

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35
Q

How are cirrhosis patients monitored for HCC

A

six-monthly intervals consisting of abdominal ultrasound and measuring AFP levels.

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36
Q

Main treatment for Hep B

A

pegylated interferon-alpha

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37
Q

vector for yellow fever

A

mosquitoes

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38
Q

features of yellow fever

A

mild flu-like illness lasting less than one week
sudden onset of high fever
rigors
nausea & vomiting
Bradycardia
A brief remission is followed by jaundice, haematemesis, oliguria

Councilman bodies (inclusion bodies) may be seen in the hepatocytes

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39
Q

alongside abx, what medication improves outcomes in bacterial meningitis patients? why is it used?

A

IV dexamethasone

by reducing neurological sequelae

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40
Q

contradictions to using dexamethasone in treatment of bacterial meningitis [4]

A

septic shock
meningococcal septicaemia.
immunocompromised
meningitis following surgery

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41
Q

treatment of UTI for symptomatic pregnant women

duration

A

first-line: nitrofurantoin (should be avoided near term)
second-line: amoxicillin or cefalexin

7 days

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42
Q

GI infection that presents as prolonged, non-bloody diarrhoea, bloating, flatulence, steatorrhoea

A

giardiasis

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43
Q

GI infection that presents as severe vomiting and short incubation period

A

staph aureus

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44
Q

GI infection that presents as gradual onset bloody diarrhoea, abdominal pain and tenderness which may last for several weeks

A

amoebiasis

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45
Q

Abx used for UTI that is contraindicated in pregnancy

A

trimethoprim

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46
Q

treating a symptomatic UTI in catheterised patient

A

7 day Abx with catheter change if its been there for more than 7 days

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47
Q

when should the repeat combined HIV test be done

A

in 12 weeks times but start ART right away

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48
Q

definition of pyrexia of unknown origin

A

Defined as a prolonged fever of > 3 weeks which resists diagnosis after a week in hospital

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49
Q

neoplastic causes of PUO [4]

A

lymphoma
hypernephroma
preleukaemia
atrial myxoma

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50
Q

which patients need a urine culture sent before ABx are started for UTI [4]

A
  • men
  • pregnant women
  • non -pregnant women over 65
  • visible or non-visible haematuria
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51
Q

how is bacteriuria treated in catheterised patients

A

no treatment if asymptomatic

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52
Q

treatment of post splenectomy sepsis

A

Penicillin V 500mg BD or amoxicillin 250mg BD

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53
Q

treatment of neutropenic sepsis

A

tazocin (piperacillin + tazobactam)

54
Q

Suspected bacterial meningitis: an LP should be done before IV antibiotics, unless [4]

A

cannot be done within 1 hour
signs of severe sepsis or a rapidly evolving rash
significant bleeding risk
signs of raised intracranial pressure

55
Q

treatment of legionella

A

clarithromycin

56
Q

treatment of latent TB [2 ways]

A

3 months of isoniazid (with pyridoxine) and rifampicin

or

6 months of isoniazid (with pyridoxine)

57
Q

investigations for mycoplasma pneumonia

name of test

A

diagnosis is generally by Mycoplasma serology
positive cold agglutination test → peripheral blood smear may show red blood cell agglutination

58
Q

treatment for mycoplasma pneumonia

A

doxycycline or macrolide

59
Q

causative agent of Kaposi sarcoma

A

HHV-8

60
Q

management of wound: Patient has had a full course of tetanus vaccines, with the last dose < 10 years ago

A

no vaccine nor tetanus immunoglobulin is required, regardless of the wound severity

61
Q

management of wound: Patient has had a full course of tetanus vaccines, with the last dose > 10 years ago

A

if tetanus prone wound: reinforcing dose of vaccine

high-risk wounds (e.g. compound fractures, delayed surgical intervention, significant degree of devitalised tissue): reinforcing dose of vaccine + tetanus immunoglobulin

62
Q

management of wound: If vaccination history is incomplete or unknown

A

reinforcing dose of vaccine, regardless of the wound severity
for tetanus prone and high-risk wounds: reinforcing dose of vaccine + tetanus immunoglobulin

63
Q

main complication of mumps

A

orchitis

64
Q

treatment of Lyme’s disease with doxycycline allergy

A

amoxicillin

65
Q

treatment of chlamydia

A

doxycycline

if pregnant: azithromycin, erythromycin or amoxicillin

66
Q

what does an aspergillioma usually grow secondary to

A

previous TB infection

67
Q

characteristic Chest X-ray sign of aspergillioma

A

The air crescent sign on chest x-ray is a characteristic finding of aspergilloma where a crescent of air that surrounds a radiopaque mass present in a lung cavity is visible.

68
Q

how many drugs does ART consist of and which drugs make it up?

A

Antiretroviral therapy (ART) involves a combination of at least three drugs

typically two nucleoside reverse transcriptase inhibitors (NRTI) and either a protease inhibitor (PI) or a non-nucleoside reverse transcriptase inhibitor (NNRTI).

This combination both decreases viral replication but also reduces the risk of viral resistance emerging

69
Q

management of syphillis

A

benzathine penicillin is the first-line management

alt: doxycycline

70
Q

what should be monitored after syphilis treatment

A

nontreponemal (rapid plasma reagin [RPR] or Venereal Disease Research Laboratory [VDRL]) titres should be monitored after treatment to assess the response

71
Q

treatment of HSV gingivostomatitis

A

gingivostomatitis: oral aciclovir, chlorhexidine mouthwash

72
Q

treatment of multiple, non-keratinised genital warts

A

topical podophyllum

73
Q

treatment of solitary, keratinised warts

A

cryotherapy

74
Q

which pneumonia does previous influenza predispose you to

A

Staphylococcus aureus

75
Q

treatment of syphilis

A

benzylpencilllin

76
Q

early phase features of leptospirosis [4]

A

may be mild or subclinical
fever
flu-like symptoms
subconjunctival suffusion (redness)/haemorrhage

77
Q

Features if typhoid [5]

A

fever
abdominal pain
constipation
‘rose’ spots
bradycardia

78
Q

which viral hepatitis is associated with thrombocytopenia

A

Hep E

79
Q

which viral hepatitis is associated with undercooked pork

A

Hep E

80
Q

which viral hepatitis is associated with shellfish

A

Hep A

81
Q

cause of Lymphogranuloma venereum (LGV)

A

Chlamydia trachomatis

82
Q

three stages of Lymphogranuloma venereum

A

stage 1: small painless pustule which later forms an ulcer
stage 2: painful inguinal lymphadenopathy
stage 3: proctocolitis

83
Q

treatment of Lymphogranuloma venereum

A

doxycycline

84
Q

investigation of choice for herpes

A

NAAT

85
Q

3 signs of Jarish-Herxheimer reaction

A

fever
tachycardia
rash

post abx, treat with paracetamol

86
Q

treatment of malaria: in areas which are known to be chloroquine-sensitive then WHO recommend [2]

A

artemisinin combination therapy (ACT)

or

chloroquine

87
Q

treatment of malaria: in areas which are known to be chloroquine-resistant use

A

Artemisinin combination therapy

88
Q

patients with ovale or vivax malaria should be given ___________ following acute treatment with chloroquine to destroy liver hypnozoites and prevent relapse

A

patients with ovale or vivax malaria should be given primaquine following acute treatment with chloroquine to destroy liver hypnozoites and prevent relapse

89
Q

investigation for Lyme’s disease

A

can start Abx upon clinical diagnosis
ELISA (serology)

90
Q

treatment of bacterial vaginosis

A

oral metronidazole 7 days

91
Q

how many tetanus vaccinations are given to provide life long immunity

A

5

92
Q

treatment of syphilis in pregnancy

A

IM benzathine penicillin

93
Q

what is seen on microscopy in BV

A

clue cells

94
Q

treatment of oral cold sore

A

topical aciclovir

95
Q

treatment of genital herpes

A

oral aciclovir

96
Q

complications of mycoplasma:
- neuro [2]
- cardio [2]
- gastro [2]
- renal [1]

A
  • neuro: GBS and immune mediated disease
  • cardio: myocarditis/pericarditis
  • gastro: hepatitis, pancreatitis
  • renal: acute glomerulonephritis
97
Q

what should be used in management of meningitis if the patient has anaphylactic allergies to penicillins and cephalosporins

A

IV chloramphenicol

98
Q

gram stain and shape of neisseria gonorrhoea

A

gram -ve diplococci

99
Q

cause of non-gonococcal urethritis

A

Mycoplasma genitalium

100
Q

how do symptoms of primary herpes infection compare to eventual recurrent episodes

A

primary infection is most severe

101
Q

what can be used to treat gonorrhoea if the patient refuses IM ceftriaxone injections [2]

A

oral cefixime + oral azithromycin

102
Q

first line treatment of Lyme’ s disease

A

doxycycline

103
Q

how does Yellow fever present [3]

A

classic description involves sudden onset of high fever, rigors, nausea & vomiting. Bradycardia may develop.
A brief remission is followed by jaundice, haematemesis, oliguria

104
Q

histological feature in hepatocytes in Yellow Fever

A

Councilman bodies (inclusion bodies) may be seen in the hepatocytes

105
Q

Disseminated gonococcal infection triad

A

tenosynovitis, migratory polyarthritis, dermatitis

106
Q

post exposure prophylaxis for HBsAg positive source

A

known responder to the HBV vaccine then a booster dose should be given

non-responder (anti-HBs < 10mIU/ml 1-2 months post-immunisation) they need to have hepatitis B immune globulin (HBIG) and a booster vaccine

107
Q

triad of infectious mononucleosis

A

sore throat, pyrexia and lymphadenopathy

other:
malaise, anorexia, headache
palatal petechiae
splenomegaly - occurs in around 50% of patients and may rarely predispose to splenic rupture
hepatitis, transient rise in ALT
lymphocytosis: presence of 50% lymphocytes with at least 10% atypical lymphocytes
haemolytic anaemia secondary to cold agglutins (IgM)
a maculopapular, pruritic rash develops in around 99% of patients who take ampicillin/amoxicillin whilst they have infectious mononucleosis

108
Q

management of infectious mononucleosis

A

rest during the early stages, drink plenty of fluid, avoid alcohol
simple analgesia for any aches or pains
consensus guidance in the UK is to avoid playing contact sports for 4 weeks after having glandular fever to reduce the risk of splenic rupture

109
Q

adverse effects of metronidazole

A

disulfiram-like reaction with alcohol
increases the anticoagulant effect of warfarin

110
Q

CMV retinitis

A

common in HIV patients with a low CD4 count (< 50)
presents with visual impairment e.g. ‘blurred vision’. Fundoscopy shows retinal haemorrhages and necrosis, often called ‘pizza’ retina
IV ganciclovir is the treatment of choice

111
Q

causes of HIV diarrhoea

A

Cryptosporidium + other protozoa (most common)
Cytomegalovirus
Mycobacterium avium intracellulare
Giardia

112
Q

Post-exposure prophylaxis for HIV: duration of treatment

A

4 weeks of ART followed by a HIV tests at 12 weeks

113
Q

which TB investigation allows to assess drug sensitivities in TB

A

sputum culture

114
Q

what is Group A strep

A

Strep pyogenes

115
Q

what is Group B strep

A

Strep agalactiae

116
Q

treatment for amoebiasis

A

metronidazole

117
Q

features of Dengue fever

A

Retro-orbital headache, fever, facial flushing, maculopapular rash, thrombocytopenia in returning traveller, bone pain,

118
Q

features of Legionella

A

flu-like symptoms including fever (present in > 95% of patients)
dry cough
relative bradycardia
confusion
lymphopaenia
hyponatraemia
deranged liver function tests
pleural effusion: seen in around 30% of patients

119
Q

Cause of false negative Mantoux tests include

A

TB
AIDS
Long-term steroid use
Lymphoma
Sarcoidosis
Extremes of age
Fever
Hypoalbuminaemia
Anaemia

120
Q

causative agent of chancroid

A

Haemophilus ducreyi.

121
Q

how does chancroid present

A

painful genital ulcers associated with unilateral, painful inguinal lymph node enlargement. The ulcers typically have a sharply defined, ragged, undermined border.

not to be confused with chancre in syphilis which are painless

122
Q

live vaccines

A

MR V-BOY
MMR
Varciella
BCG
Oral polio
Yellow Fever

123
Q

what must be done before giving the BCG

A

tuberculin skin test

124
Q

Ebola presentation

what is the incubation period

A

First symptoms are the sudden onset of fever fatigue, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, symptoms of impaired kidney and liver function, and in some cases, both internal and external bleeding.

The incubation period is 2 to 21 days, and patients are not infectious until they develop symptoms.

125
Q

do human bites require HIV PEP

A

no

126
Q

EBV associated malignancies

A

Burkitt’s lymphoma
Hodgkin’s lymphoma
nasopharyngeal carcinoma

127
Q

treatment of disseminated Lyme disease

A

ceftriaxone

128
Q

Amsel’s criteria for diagnosis if BV

A

3 of 4

thin, white homogenous discharge
clue cells on microscopy: stippled vaginal epithelial cells
vaginal pH > 4.5
positive whiff test (addition of potassium hydroxide results in fishy odour)

129
Q

which condition has rose spots

A

salmonella typhi

130
Q

which condition has an increased risk of GI perforation

A

salmonella typhi

131
Q

most common cause of osteomyelitis in those with SCD

A

salmonella

Year 6 (19 decks)

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