Infection formative Flashcards
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
d. norovirus
Rotavirus in kids.
What is the most likely cause of travellers diarrhoea?
a. campylobacter
b. cryptosporidium
c. e.coli O157
d. enterotoxigenic e.coli
e. giardia
d. enterotoxigenic e.coli
Campylobacter commonest cause of ‘regular’ diarrhoea. E.coli O157 more associated with farm animals
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
b. clostridium difficile
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
All of above
Is septic shock. Need to do SEPSIS6 for management
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
b. rifampicin/ciprofloxacin
Septic shock caused by neisseria mengitidis (meningicoccal shock)
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
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)
What component of Neisseria meningitidis causes septic shock?
a. capsule
b. fimbriae
c. lipo-polysaccharide
d. peptidoglycan
e. superantigens
c. lipo-polysaccharide
Endotoxin production associated with lipo-polysaccharide (in meningococcal shock)
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
b. he has acute hep A infection
HAV IgM always rises in acute infection of hep A but IgG prevails longer term
For which of the following is there no vaccine?
a. hep A
b. hep C
c. polio
d. typhoid
e. yellow fever
b. hep C
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
d. stimulates host immune response
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
d. candica albicans
Is thrush
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
c. commence at least 3 ARTs
Wouldn’t do BCG vaccine as it is a live vaccine - patient is immunosuppressed with HIV
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
c. wash wound and encourage bleeding
Risk of blood borne virus transmission
a. HIV risk is highest
b. hep C risk is highest
c. hep B risk is highest
c. hep B risk is highest
What is commonest bacterial cause of infective diarrhoea in UK?
a. salmonella
b. E. coli O157
c. campylobacter
d. entamoeba histolytica
c. campylobacter
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
c. high protein, low glucose, gram -ve cocci
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. biliary sepsis
Gastroenteritis doesn’t cause bacteraemia
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
e. pulmonary tuberculosis
Longer time period. Miliary TB would be multi system disease. Consolidation on x-ray confirmss diagnosis
What rapid test confirms TB diagnosis?
a. gram stain
b. india ink
c. overnight culture
d. ZN/auramine stain
d. ZN stain
This TB patient should be initially treated with:
a. rifampicin
b. isoniazid
c. ethambutol
d. pyrazinamide
e. all of above
e. all of above
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
e. legionella
Hyponatraemia and high ALT, has been abroad
How do you confirm the Legionella diagnosis?
a. blood culture
b. serology
c. sputum culture
d. urinary antigen
d. urinary antigen
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
d. E.coli O157
What antibiotic would you commence for E.coli?
a. flucoxacillin
b. gentamycin
c. metronidazole
d. none
e. ceftriaxone and metronidazole
d. none
Antibiotics release more toxins in e.coli infection. Is toxin mediated infection
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
d. malaria film +/- antigen test
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
b. IV artesunate
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. strep pneumoniae
If she is alert, Urea was 8, RR was 32, BP was 110/60 and is 47, what is the CURB 65 score?
3
With a CURB 65 score of 3 what should her treatment be?
IV Co-amoxiclav and clarithromycin
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
b. empyema
What are 3 management steps of dealing with empyema?
- US guided diagnostic aspiration
- Drainage
- Antibiotics
