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Year 3 MedEd > Infections > Flashcards

Infections Flashcards

Infections

1
Q

What is glandular fever also known as?

A

Infective mononucleosis

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2
Q

What is the most common cause of infective mononucleosis?

A

EBV

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3
Q

What proportion of people have had infective mononucleosis?

A

90% of world population

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4
Q

What is the classic triad of infective mononucleosis?

A

Lymphadenopathy
Pharyngitis
Fever

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5
Q

How is infective mononucleosis transmitted?

A

Kissing disease- saliva
Sexual transmission
Blood products, organ transplant

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6
Q

How may infective mononucleosis present?

A

Fever 1-2 weeks
Lymphadenopathy
Pharyngitis
Photophobia, cough, fatigue, headache, splenomegaly

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7
Q

What are the investigations for infective mononucleosis?

A 
FBC:
-lymphocytosis
-atypical lymphocytosis
Heterophile antibodies
-monospot test
-positive heterophile antibodies
EBV specific receptors (high sensitivity)
Real time PCR
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8
Q

What are the three EBV specific receptors measured?

A

Viral caspid antigen IgM
Viral caspid antigen IgG
Epstein-Barr nuclear antigen IgG (EBNA IgG)

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9
Q

What EBV specific receptors will be seen in a healthy Ptwithout EBV?

A
  • ve VCA IgM
  • ve VCA IgG
  • ve EBNA IgG
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10
Q

What EBV specific receptors will be seen a Pt with early infective mononucleosis?

A

+ve VCA IgM

  • ve VCA IgG
  • ve EBNA IgG
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11
Q

What EBV specific receptors will be seen a Pt with acute infective mononucleosis?

A

+ve VCA IgM
+ve VCA IgG
-ve EBNA IgG

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12
Q

What EBV specific receptors will be seen a Pt with a history of infective mononucleosis?

A

-ve VCA IgM
+ve VCA IgG
+ve EBNA IgG

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13
Q

What is the management for a Pt with infective mononucleosis?

A 
Supportive care (paracetamol, hydration etc)
Corticosteroids if URT obstruction, haemolytic anaemia, or thrombocytopaenia
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14
Q

Why should you not give aspirin to children?

A

Risk of developing Reye’s syndrome

Causes swelling in the liver and brain

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15
Q

What are the two conditions caused by varicella zoster infections?

A 
Chicken pox (aka varicella)
Shingles (aka herpes zoster)
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16
Q

What are the characteristics of varicella?

A

Fever
Malaise
Generalised pruritic vesicular rash

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17
Q

What are the characteristics of herpes zoster?

A

Reactivation of VZV

Dermatomal distribution of rash

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18
Q

What are the risk factors for a VZV infection?

A

> 50 yrs or child
HIV +ve
Chronic corticosteroid use
aka any form of immunosuppression

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19
Q

What are the investigations for a VZV infection?

A

Clincial diagnosis

Can consider PCR, viral culture, ELISA

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20
Q

What is the management for varicella?

A

Supportive care
Paracetamol
Diphenhydramine (antihistamine)

Avoid aspirin and NSAIDs

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21
Q

What is the management for herpes zoster?

A

Antiviral therapy:
1st line- famciclovir/valaciclovir
2nd line- acyclovir

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22
Q

What are the complications of VZV?

A

Ocular complications
Meningoencephalitis
Peripheral nerve palsy
Spinal cord myelitis

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23
Q

What can a HSV1 infection cause?

A

Herpes labialis
Genital herpes
HSV encephalitis

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24
Q

What can a HSV2 infection cause?

A

Genital herpes

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25
Q

How may a HSV1 infection present?

A 
Gingivostomatitis/cold sores
Herpetic whitlow (vesicles in fingers)
Eczema herpeticum
Systemic signs (fever, sore throat, lymphadenopathy)
Herpes simplex encephalitis
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26
Q

How may a HSV2 infection present in a male?

A 
Vesicles on shaft or glands
Proctitis with discharge
Rectal pain
Tenesmus
Constipation
Impotence
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27
Q

How may a HSV2 infection present in a female?

A

Genital pain
Discharge
Dysuria
Ulcerative lesions

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28
Q

What are the investigations for HSV infections?

A

Viral culture
HSV PCR
Glycoprotein G-based type specific serology (gG1 and gG2)

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29
Q

What type of virus is HIV caused by and what cells does it infect?

A

Retrovirus

Human lymphocytes/macrophages

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30
Q

What are the routes of HIV transmission?

A 
Sexual contact
Before birth
During delivery
Breast feeding
IVDU
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31
Q

What are the 3 stages of HIV infection?

A

Primary
Asymptomatic
AIDS-related complex

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32
Q

What is the primary HIV stage?

A

2-6 weeks transient illness

Fever, malaise, myalgia, pharyngitis, generaised lymphadenopathy

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33
Q

What is the asymptomatic HIV stage?

A

Persistent generalised lymphadenopathy
FLAWs, diarrhoea after a while
CD4 <400x10^6

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34
Q

What is the AIDS-related complex HIV stage?

A

Opportunistic infections

CD4 200x10^6

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35
Q

What is the cause of oral candidiasis?

A

Fungal candida infection

Due to immunosuppression

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36
Q

What is the cause of hairy leukoplakia?

A

Triggered by EBV

White patches appear on tongue/inside cheek

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37
Q

What is the cause of Kaposi’s sarcoma?

A

Human herpes virus 8

Pink/violaceous path on skin/mouth

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38
Q

What are the investigations for HIV?

A 
ELISA
Serum HIV rapid test
Sample buccal saliva
HIV PCR
CD4 count
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39
Q

What are some common pathogens that cause tonsillitis?

A 
Rhinovirus
Coronavirus
Adenovirus
Beta-haemolytic/streptococci
Mycoplasma pneumoniae
Neisseria gonorrhoea
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40
Q

What are the features of tonsillitis?

A 
Pain on swallowing
Fever
Tonsillar exudate
Sudden onset sore throat
Tonsillar erythema
Tonsillar enlargement
Anterior cervical lymphadenopathy
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41
Q

What are the investigations for tonsillitis?

A

Throat culture

Rapid streptococcal antigen test

42
Q

What are the common locations of candidiasis?

A

Mouth

Genitals

43
Q

What is systemic candidiasis?

A

Acute disseminated candidiasis to blood, pleura and peritoneal fluid
Associated with fever, hypotension and leukocytosis

44
Q

What are the risk factors for candidiasis?

A 
HIV
Malnutrition
Diabetes
Malignancy
Chemotherapy/radiotherapy
Other forms of immunosuppression
45
Q

What are the investigations for candidiasis?

A

Superficial smear for microscopy
Urinalysis
Random/fasting glucose

46
Q

What are the pathogens that cause the common cold?

A 
Rhinoviruses (50%) 
Coronavirus (10-15%)
Influenza (5-15%) 
Parainfluenza (5%) 
Respiratory syncytial virus (5%)

Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis

47
Q

What is the investigation for the common cold?

A

Clinical diagnosis

48
Q

What is the management for the common cold?

A

Hydration
Antipyretic/analgesic
Decongestant
Antitussive

49
Q

What is an abscess?

A

A collection of pus within a tissue/organ/confined space

50
Q

What are the features of an abscess?

A 
Erythema
Hot
Oedema
Pain
Loss of function
Fever
Systemically unwell
51
Q

What is the investigation for an abscess?

A

Clinical diagnosis

52
Q

What is the management for an abscess?

A

Incision and drainage
Only give antibiotics if severe eg:
Sepsis, cellulitis, multiple sites of infection

53
Q

What is Bartholin’s abscess?

A

A build up of pus in one of Bartholin’s glands, found on each side of the vaginal opening

54
Q

What is Quinsy’s abscess?

A

A build up of pus between one of the tonsils and the wall of the throat

55
Q

What is a pilonidal abscess?

A

A build up of pus in the skin of the cleft of the buttock

56
Q

What are the common causes of meningitis?

A

Streptococcus pneumoniae
Neisseria meningitidis
Haemophilus influenza type B

57
Q

What is a common cause of encephalitis?

A

Herpes virus

58
Q

What are the features of meningitis?

A

Stiff neck
Photophobia
Non-blanching rash

59
Q

What are the features of encephalitis?

A 
Altered state of consciousness
Seizures
Personality change
Cranial nerve palsies
Speech problems
Motor and sensory deficit
60
Q

What are the investigations of meningitis?

A

LP if there are no clinical features of raised ICP

61
Q

What is the management for meningitis?

A

Empirical antimicrobial therapy

  • ceftriaxone
  • vancomycin
62
Q

What is Brudzinski’s sign?

A

Neck flexion causes hip and knee to flex

63
Q

What is Kernig’s sign?

A

Cannot straighten leg when hip is at 90 degrees

64
Q

What does the following CSF sample show?

Appearance- clear
WCC- low
Protein- normal
Glucose- normal
Gram stain- NA
A

Normal CSF

65
Q

What does the following CSF sample show?

Appearance- turbid
WCC- high neutrophil
Protein- high
Glucose- low
Gram stain- positive
A

Gram positive bacterial meningitis

eg. Streptococcus pneumoniae

66
Q

What does the following CSF sample show?

Appearance- turbid
WCC- high neutrophil
Protein- high
Glucose- low
Gram stain- negative
A

Gram negative bacterial meningitis

eg. Neisseria meningitidis

67
Q

What does the following CSF sample show?

Appearance- clear/cloudy
WCC- high lymphocyte
Protein- raised
Glucose- normal
Gram stain- NA
A

Viral meningitis

68
Q

What does the following CSF sample show?

Appearance- clear/cloudy
WCC- high lymphocytes
Protein- raised
Glucose- low
Gram stain- NA
A

TB/Fungal meningitis

69
Q

What further investigation could be done to differentiate between a TB and fungal meningitis?

A

Ziehl-Neeslon stain- TB

India ink stain- fungal

70
Q

What are the risk factors for infective endocarditis?

A 
Rheumatic heart disease Hx
Age-related valvular degeneration
Prosthetic valve (S. epidermidis)
IVDU (Staph. aureus)
Dental procedures (S. viridans)
71
Q

What are the investigations and management for infective endocarditis?

A

3 blood cultures at least 1hr apart within 24hrs
Urgent echo
Broad spec antibiotics

72
Q

Which infections can cause gastroenteritis with diarrhoea?

A 
Campylobacter/C difficile
Staph aureus
Vibrio cholera
E. coli
Bacillus cereus
73
Q

Which infections can cause gastroenteritis with dysentery?

A 
CHESS
Campylobacter/C difficile
Haemorrhagic E. coli
Entamoeba histolytica
Shigella
Salmonella
74
Q

What are the investigations for gasteroenteritis?

A

FBC

Stool MC+S

75
Q

How is Hep A and E transmitted?

A

Faecal-oral route

76
Q

What is the management for Hep A and E?

A

Supportive care

77
Q

What are the clinical features of Hep B?

A 
Flu-like prodrome
Rash
Lymphadenopathy
RUQ pain
Jaundice
78
Q

What are the risk factors for Hep B?

A

Unprotected sex
MSM
IVDU
Blood transfusion

79
Q

What is the management for Hep B?

A

Acute- supportive

Chronic- peginterferon alpha, Tenofovir

80
Q

Can you get Hep D without Hep B?

A

No

81
Q

What is the main worry for Hep B/C?

A

Risk of HCC

82
Q

What are the common pathogens of UTIs?

A

Escherichia coli
Staphylococcus saprophyticus
Proteus mirabilis
Enterococci

83
Q

What are the investigations for a UTI?

A

Dipstick urinalysis- positive nitrates +/- leukocytes
Urine microscopy- leukocytes
Urine MC&S
Abdo USS- exclude urinary tract obstruction or renal stones

84
Q

What is the management for a UTI?

A

Trimethoprim

85
Q

What are the five types of malaria?

A 
Plasmodium falciparum
Plasmodium vivax
Plasmodium ovale
Plasmodium malariae
Plasmodium knowlesi
86
Q

What are the characteristics of Plasmodium flaciparum?

A 
Most threatening
Common in tropical regions:
Sub-Saharan Africa
South east Asia
Oceania
Amazon basis of South America
87
Q

What are the features of malaria?

A 
Headache
Weakness
Myalgia
Arthralgia
Anorexia
Diarrhoea
Fever - Characteristic paroxysms of chills and rigors followed by fever and sweats may be described
88
Q

What are the investigations for malaria?

A

Giemsa-stained thick and thin stains
Thick- detects parasites
Thin- identifies species

FBC, Clotting profile, U+E, LFTs, blood glucose, Urinalysis, ABG

89
Q

A 30 yo lady on the HIV ward has white plaques all over her tongue that extend into her throat. She says it’s very painful to swallow.
What is the most likely causative organism?

A. Candida albicans
B. Epstein-Barr virus
C. Herpes Simplex Virus
D. Streptococcal throat infection
E. Human Herpes Virus 8
A

A. Candida albicans

90
Q

A 50 year old homeless man presents to A&E with purple purpural lesions on his back and on his gums.
What is the most likely causative organism?

A. HHV-2
B. HHV-4
C. HHV-5
D. HHV-7
E. HHV-8
A

E. HHV-8

91
Q

A 26 year old architect presents to GP with a history of sharp tingling around his lips followed by a painful ulcer on the side of his mouth. O/E he has cervical lymphadenopathy and a blister on his finger.
What is the pathogen?

A. Varicella Zoster Virus
B. Epstein-Barr Virus
C. Herpes Simplex Virus 1
D. Herpes Simplex Virus 2
E. Cytomegalovirus
A

C. Herpes Simplex Virus 1

92
Q

A 20 year old medical student presents with sore throat, headache, myalgia and coryzal symptoms. O/E she has cervical lymphadenopathy, enlarged exudative tonsils and splenomegaly.
What is the most likely diagnosis?

A. Varicella Zoster Virus
B. Epstein-Barr Virus
C. Herpes Simplex Virus 1
D. Herpes Simplex Virus 2
E. Cytomegalovirus
A

B. Epstein-Barr Virus

93
Q

A 20 year old medical student presents with sore throat, headache, myalgia and coryzal symptoms. O/E he has cervical lymphadenopathy, enlarged exudative tonsils and splenomegaly.
What is the most appropriate management?

A. Rest at home, paracetamol
B. Amoxicillin
C. Acyclovir
D. Ceftriaxone
E. Vancomycin
A

A. Rest at home, paracetamol

94
Q

A 15 year old female patient presents to A&E with difficulty speaking. 4 days ago she experienced a sore throat, which progressively got worse. It’s now difficult for her to speak or swallow. She has not had a cough or cold recently.
O/E there is bilateral tonsillar exudate and the oropharynx is not erythematous. There are 3 tender swellings on the anterior border of the sternocleidomastoid muscle.
Her observations are: T 39.1, HR 90, BP 113/68, SpO2 97%
What is the most likely diagnosis?

A. Infectious mononucleosis
B. Viral tonsillitis
C. Common cold
D. Bacterial tonsillitis 
E. Chickenpox
A

D. Bacterial tonsillitis

95
Q

A 22 year old university student is seen in the GP with a fever, headache, neck stiffness and photophobia. Which is the most likely causative organism in this patient?

A. Bacterial meningitis due to Haemophilus influenzae
B. Bacterial meningitis due to Neisseria meningitides
C. Bacterial meningitis due to Streptococcus pneumoniae
D. Fungal meningitis

A

B. Bacterial meningitis due to Neisseria meningitides

96
Q

A 22 year old university student is seen in the A&E with a fever, headache, neck stiffness and photophobia. A lumbar puncture was performed. The appearance of the fluid is clear, there are raised proteins and normal glucose. Lymphocyte count is raised. What is the most likely cause of this?

A. Bacterial meningitis
B. Drug induced meningitis
C. Fungal meningitis
D. TB meningitis 
E. Viral meningitis
A

E. Viral meningitis

97
Q

40 year old woman returns from holiday in Vietnam. She started getting diarrhoea after eating some local food on her last day in Vietnam. She presents with fever, nausea and is sore all over. The white of her eyes are yellow.
What is the most likely causative organism?

A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis D
E. Hepatitis E
A

A. Hepatitis A

98
Q

A 29 yo male comes to the GP with fever, fatigue, joint pain and urticaria-like skin rash. He had unprotected anal sex a month ago. He comes back a week later for a blood test, which shows raised ALT and AST. He now complains of feeling sick, RUQ pain and looks a bit yellow.
What is the most likely causative organism?

A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis D
E. Hepatitis E
A

B. Hepatitis B

99
Q

A 70 yo M has been in hospital for the past two weeks for severe pneumonia. He develops bloody diarrhoea, colitis and reduced urine output. He has raised CRP, WCC and low albumin.
What is the most likely causative organism?

A. Campylobacter
B. C. Difficile 
C. Bacillus cereus
D. E. Coli
E. Vibrio cholera
A

B. C. Difficile

100
Q

A 20 year old medical student comes back from their holiday and presents to A&E with profuse diarrhoea of rice water appearance. There is no blood.
What is the most likely cause?

A. Entamoeba histolytica
B. Staph aureus
C. Bacillus cereus
D. E. Coli
E. Vibrio cholera
A

E. Vibrio cholera

101
Q

A 40 yo woman presents to A&E with bloody, foul smelling diarrhoea. She went to a barbeque yesterday where she suspects she ate undercooked chicken. She has a fever and severe abdominal pain.
What is the most likely cause?

A. Campylobacter
B. Shigella
C. Bacillus cereus
D. E. coli 
E. Salmonella
A

A. Campylobacter

Year 3 MedEd (29 decks)

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