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Yr 3 Infection > Infection formative > Flashcards

Infection formative Flashcards

1
Q

What is most likely to cause an outbreak of nausea and vomiting on a cruise ship?

a. adenovirus
b. enteroviruses
c. epstein barr virus
d. norovirus
e. rotavirus

A

d. norovirus

Rotavirus in kids.

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2
Q

What is the most likely cause of travellers diarrhoea?

a. campylobacter
b. cryptosporidium
c. e.coli O157
d. enterotoxigenic e.coli
e. giardia

A

d. enterotoxigenic e.coli

Campylobacter commonest cause of ‘regular’ diarrhoea. E.coli O157 more associated with farm animals

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3
Q

Which of the following is not diagnosed by culture?

a. campylobacter jejuni
b. clostridium difficile
c. e.coli O157
d. salmonella enterica
e. vibrio cholerae

A

b. clostridium difficile

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4
Q

22yo presents in A+E with purple rash on hand with patches on chest/abdo/legs. Developed over 6h. Is hypotensive and pyrexial.

What are your immediate actions?

a. call for senior help
b. give fast IV fluids
c. IV high dose cephalosporin
d. blood culture
e. all of above

A

All of above

Is septic shock. Need to do SEPSIS6 for management

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5
Q

What should the patients family be given for prophylaxis against this type of septic shock (purple rash)?

a. amoxicillin/chloramphenicol
b. rifampicin/ciprofloxacin
c. chloramphenicol/cefalexin
d. cefalexin/trimethoprim
e. none of above

A

b. rifampicin/ciprofloxacin

Septic shock caused by neisseria mengitidis (meningicoccal shock)

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6
Q

4 days later the meningicoccal septic shock patient gets hypotensive and is hyponatraemic/hyperkalaemic, The most likely reason is:

a. too little saline in IV fluid regime
b. syndrome of inappropiate ADH secretion
c. adrenal insufficiency
d. renal failure
e. antibiotic-associated diarrhoea

A

c. adrenal insufficiency

Meningicoccal sepsis causes bleeding in adrenal gland so get adrenal insufficiency. Can occur in other infections eg TB (waterhouse-friederickson syndrome SPECIFIC to meningicoccal sepsis and TB)

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7
Q

What component of Neisseria meningitidis causes septic shock?

a. capsule
b. fimbriae
c. lipo-polysaccharide
d. peptidoglycan
e. superantigens

A

c. lipo-polysaccharide

Endotoxin production associated with lipo-polysaccharide (in meningococcal shock)

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8
Q

A 30yo IV drug user admitted with jaundice with these blood results

  • HBV surface antigen negative
  • HBV core antigen negative
  • HBV surface antibody positive
  • HAV IgM antibody positive

What is going on with this patient?

a. he has acute hep B infection
b. he has acute hep A infection
c. he previously had hep B infection
d. he hasn’t been immunised against hep B

A

b. he has acute hep A infection

HAV IgM always rises in acute infection of hep A but IgG prevails longer term

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9
Q

For which of the following is there no vaccine?

a. hep A
b. hep C
c. polio
d. typhoid
e. yellow fever

A

b. hep C

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10
Q

Which of the following is true of active immunisation

a. always contains live organism
b. contains immunoglobulin
c. gives immediate protection against infection
d. stimulates host immune response

A

d. stimulates host immune response

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11
Q

28 yo man presents with 3w history of swallowing difficulties (pic with white patches around palate of mouth). Most likely causative organism is

a. EBV
b. HIV
c. HZV
d. candida albicans
e. group A streptococci

A

d. candica albicans

Is thrush

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12
Q

He is found to be HIV positive. Candida treated with Fluconazole. Further treatment should be:

a. beetroot
b. immunise with BCG as he is at great risk of TB
c. commence at least 3 ARTs
d. wait until AIDS defining illness and then commence ARTs
e. immunotherapy with HIV vaccine

A

c. commence at least 3 ARTs

Wouldn’t do BCG vaccine as it is a live vaccine - patient is immunosuppressed with HIV

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13
Q

When taking blood from acutely ill HIV positive patient you accidentally stab yourself with needle. What do you do first

a. phone on call OH doctor
b. call registrar
c. wash wound and encourage bleeding
d. phone MBChB office

A

c. wash wound and encourage bleeding

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14
Q

Risk of blood borne virus transmission

a. HIV risk is highest
b. hep C risk is highest
c. hep B risk is highest

A

c. hep B risk is highest

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15
Q

What is commonest bacterial cause of infective diarrhoea in UK?

a. salmonella
b. E. coli O157
c. campylobacter
d. entamoeba histolytica

A

c. campylobacter

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16
Q

In meningococcal meningitis, what would you expect in CSF?

a. high protein, high glucose, gram +ve bacilli
b. low protein, low glucose, gram +ve cocci
c. high protein, low glucose, gram -ve cocci

A

c. high protein, low glucose, gram -ve cocci

17
Q

You have isolated E.coli from two blood cultures taken from jaundiced patient admitted with septic shock. Which is most likely source?

a. biliary sepsis
b. gastroenteritis
c. infective endocarditis
d. osteomyelitis
e. pneumonia

A

a. biliary sepsis

Gastroenteritis doesn’t cause bacteraemia

18
Q

27yo presents with 6w of dry cough, weight loss and fevers, 3m after returning from Bolivian orphanage work. Most likely diagnosis?

a. miliary TB
b. HIV
c. mycoplasma pneumonia
d. pneumococcal pneumonia
e. pulmonary tuberculosis

A

e. pulmonary tuberculosis

Longer time period. Miliary TB would be multi system disease. Consolidation on x-ray confirmss diagnosis

19
Q

What rapid test confirms TB diagnosis?

a. gram stain
b. india ink
c. overnight culture
d. ZN/auramine stain

A

d. ZN stain

20
Q

This TB patient should be initially treated with:

a. rifampicin
b. isoniazid
c. ethambutol
d. pyrazinamide
e. all of above

A

e. all of above

21
Q

50yo male smoker returns from Spain with 2w cough, SOB, sputum, diarrhoea. Is tachycardic, tachypnoeic, hypotensive, feverish, cyanosed, dehydrated, and has bilateral basal consolidation. Has hyponatraemia and high ALT and high CRP.
Which organism is responsible?

a. influenza A
b. E.coli
c. strep pneumoniae
d. mycoplasma
e. legionella

A

e. legionella

Hyponatraemia and high ALT, has been abroad

22
Q

How do you confirm the Legionella diagnosis?

a. blood culture
b. serology
c. sputum culture
d. urinary antigen

A

d. urinary antigen

23
Q

5yo girl, developed diarrhoea 3d ago. Has abdominal pain/tenderness and reduced urine output, hypertensive and low temp.
Investigations show low Hb, high WBC, low platelets, high urea, high creatinine.
Most likely infecting organism?

a. campylobacter
b. shigella dysentery
c. cryptorsporidium
d. E.coli O157

A

d. E.coli O157

24
Q

What antibiotic would you commence for E.coli?

a. flucoxacillin
b. gentamycin
c. metronidazole
d. none
e. ceftriaxone and metronidazole

A

d. none

Antibiotics release more toxins in e.coli infection. Is toxin mediated infection

25
Q

28yo returns from working in Nigeria. Is febrile, vomiting and unwell. Most important investigation?

a. CXR
b. blood cultures
c. urgent stool microscopy and typhoid culture
d. malaria film +/- antigen test
e. urgent HIV test

A

d. malaria film +/- antigen test

26
Q

Blood film confirms Plasmodium falciparum and parasitaemia of 6%. Treatment?

a. artemether/lumefantrine (ACT)
b. IV artesunate
c. IV ciprofloxacin
d. oral quinine unless parasitaemia increases
e. chloroquinine IV/orally if tolerated

A

b. IV artesunate

27
Q

In lady with mild asthma, who hasn’t been abroad, has pneumonia symptoms . What is likely causative organism?

a. strep pneumoniae
b. mycoplasma
c. staph aureus
d. legionella
e. haemophilus influenzae

A

a. strep pneumoniae

28
Q

If she is alert, Urea was 8, RR was 32, BP was 110/60 and is 47, what is the CURB 65 score?

A

3

29
Q

With a CURB 65 score of 3 what should her treatment be?

A

IV Co-amoxiclav and clarithromycin

30
Q

If pneumonia patient presents with what looks like pleural effusion on CXR after being treated, what is likely diagnosis?

a. post pneumonic effusion
b. empyema
c. ongoing pneumonia
d. none of above

A

b. empyema

31
Q

What are 3 management steps of dealing with empyema?

A
  • US guided diagnostic aspiration
  • Drainage
  • Antibiotics

Yr 3 Infection (12 decks)

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