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Revision Qs > Infectious Disease 1 > Flashcards

Infectious Disease 1 Flashcards

1
Q

Particular food implicated in Hep A transmission?

A

Shellfish

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2
Q

Symptoms of Hep A?

A

Nausea, vomiting, malaise
Arthralgias
Rash

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3
Q

Signs of Hep A?

A

Jaundice
Fever
Lymphadenopathy
Hepatosplenomegaly

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4
Q

What test is diagnostic of Hep A?

A

anti-HAV IgM

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5
Q

What test can be used to investigate previous HAV infection?

A

anti-HAV IgG

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6
Q

3 preventative measures for Hep A?

A

Good sanitation in developing countries
Good hygiene practises
IgG vaccine

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7
Q

How is HBV transmitted?

A

Blood-borne, sexual/bodily fluids and vertically

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8
Q

Particular RFs for HBV infection?

A 
Sexual contact with infected person
IVDU
Tattoos, particularly foreign countries
Medical treatment abroad
Blood transfusions before 1991
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9
Q

What 3 features are more prominent in HBV than HAV if present?

A

Rash
Jaundice
Arthralgia

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10
Q

How does HBV often present?

A

It’s often asymptomatic; otherwise like a more severe HAV with prominent jaundice, rash and arthralgia

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11
Q

What blood tests indicate an acute HBV infection?

A

HBcIgM, HBcIgG
HBsAg
HBV DNA
Acutely deranged LFTs

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12
Q

What 2 blood markers are only found during the acute phase of HBV infection?

A

HBsAg

HBV DNA

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13
Q

What is HBV DNA used to monitor?

A

Treatment and infectivity

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14
Q

What unusual HBV marker is used to indicate high infectivity?

A

HBeAg

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15
Q

What blood tests indicate if someone has had a past HBV infection and recovered?

A

HBsAb

HBcIgG

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16
Q

What blood test indicates someone who has been vaccinated against HBV?

A

HBsAb (but no HBcIgG)

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17
Q

What blood test is used as a screening test for HBV?

A

HBsAg

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18
Q

Someone is HBV DNA, HBsAg positive as well as HBcIgM positive and has deranged LFTs. Diagnosis?

A

Acute infection

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19
Q

Someone is positive only for HBsIg. Diagnosis?

A

Vaccinated therefore immune

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20
Q

Someone is positive for HBsIg and HBcIgG. Diagnosis?

A

Immune due to previous infection

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21
Q

Someone is positive for HBsAg, HBcIgG and HBeAb but negative for HBcIgM and HBsIg. Diagnosis?

A

Chronic infection

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22
Q

What is the most likely outcome of HBV infection?

A

Complete recovery -

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23
Q

What LFT picture does Hep A give?

A

Hepatic damage + raised bilirubin

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24
Q

Apart from complete recovery and chronicity how else can HBV infection resolve?

A

Carrier state

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25
Q

What 3 blood tests indicate chronic HBV infection?

A

HBsAg
HBcIgG
HBeAb

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26
Q

How is HCV spread?

A

Bloodborne, sexual, vertical

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27
Q

If hep C presents symptomatically, how does it present?

A

Milder flu-like illness with fever +/- jaundice

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28
Q

How is HCV infection detected in the acute phase?

A

HCV RNA (PCR) + deranged LFTs

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29
Q

How is chronic HCV infection detected?

A

Anti-HCV Abs

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30
Q

What proportion of HCV goes on to become chronic? Future complications?

A

2/3 chronic
1/3 liver cirrhosis
1/10 HCC

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31
Q

Treatment of HCV? (Chronic)

A

PEG interferon alpha

Ribavirin

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32
Q

Prevention of HBV?

A

Vaccine (HBsAb)

Safe sex, clean needles, blood screening etc.

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33
Q

Is there a vaccine for HCV?

A

No

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34
Q

What is the role of Hep D virus infection?

A

Can only occur in context of HBV as it is an incomplete RNA virus

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35
Q

How is HDV spread?

A

In the blood

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36
Q

2 types of HDV infection?

A

Occurring at same time to make more severe infection (co-infection)
Causing flare up of chronic infection (superinfection)

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37
Q

Investigating HDV infection?

A

HDV RNA (PCR)

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38
Q

Treatment of HDV virus?

A

Alpha interferon (limited success)

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39
Q

Potential implications of HDV infection?

A

Increased risk of fulminant hepatitis and liver failure

But no chronic state

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40
Q

How is HDV prevented?

A

HBV vaccine!

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41
Q

How is HEV spread?

A

Fecal oral

But more like pork, deer, water supplies (and sexual)

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42
Q

Where is HEV common?

A

Indochina

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43
Q

Symptoms of HEV?

A

Similar to HAV - icterus, flu like Sx, pruritis, organomegally

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44
Q

What are the 2 phases of HAV infection?

A 
Prodromal phase (non-specific, nausea vom headaches etc.)
Icteric phase (jaundice, fever, pruritis etc.)
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45
Q

How is HEV infection detected?

A

HEV RNA serology (PCR) via serum or stool

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46
Q

In whom does HEV infection carry particular significance?

A

Pregnant women - mega high mortality

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47
Q

What food is implicated in HEV infection?

A

Pork, deer

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48
Q

How is Hep A transmitted?

A

Fecal-oral route - contaminated food and water

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49
Q

Acute presentation of mastoiditis?

A

Often follows acute or recurrent OM, bulging erythematous TM
Otalgia, retroaural pain (swelling, redness, boggy)
Fever and malaise
Discharge and perforation

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50
Q

What CN and hearing findings might be consistent with mastoiditis?

A

CN5, 7, 8 involvement

Conductive deafness

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51
Q

Potential complications of mastoiditis?

A

Intracranial infection - meningitis, abscess

52
Q

Subacute presentation of allergic extrinsic alveolitis?

A

Pneumonitis

53
Q

Examples of allergic extrinsic alveolitis?

A 
Farmers lung (hay)
Pigeon fanciers lung (feathers and avian proteins)
Cheese workers lung (penicillium casei)
Malt workers lung
Hot tub lung (mycobacterium Avium)
54
Q

Signs of chronic allergic extrinsic alveolitis?

A

SOB and weight loss over time
Cyanosis, clubbing
Can lead to cor pulmonale

55
Q

What are the most common viral meningitides?

A

HHV meningitis
Enterovirus associated
Complications of childhood disease
HIV-associated

56
Q

3 most common causes of bacterial meningitis?

A

Neisseria meningitidis
Haemophilus influenzae B
Pneumococcus

57
Q

Bacterial meningitis with particular relevance in pregnancy?

A

Listeria monocytogenes

58
Q

Bacterial meningitis with particular relevance in neonates?

A

GBS (strep viridans)

59
Q

Aseptic meningitis causes?

A

Viral or partially treated bacterial
Fungal - cryptococcus, aspergillus etc.
Parasitic e.g. Toxoplasma

60
Q

Differentiating between meningitis and encephalitis signs and symptoms?

A

Encephalitis typically has more reduction in consciousness level +/- focal neurological signs, meningitis is more about the meningism

61
Q

Features of cerebral abscess?

A

Swinging fever and signs
Signs of raised ICP - Papilloedema, postural headache, reduced consciousness
Focal signs - visual fields?

62
Q

Quad of acute bacterial meningitis?

A

Fever
Headache
Neck stiffness and photophobia
Altered mental state

63
Q

4 contraindications to LP for meningitis?

A

Any signs of ICP - risk of coning
Acutely reduced consciousness
Focal neurological signs
Immunodeficiency

64
Q

What LP findings does bacterial meningitis provide?

A

Neutrophilia
High exudative protein count
Low glucose

65
Q

What LP findings does viral meningitis provide?

A

Lymphocytosis
Slightly raised protein if at all
Normal glucose

66
Q

What LP findings does fungal or TB meningitis demonstrate?

A

Lymphocytosis
Very high protein - chronicity
Normal or lowered glucose

67
Q

Is LP is contraindicated acutely, what investigation should be done instead?

68
Q

Urgent treatment if suspecting meningococcal sepsis?

A

Benpen IM ASAP before transfer etc.

Then start on ceftriaxone/cefotaxime

69
Q

What prophylaxis is used for contacts of bacterial meningitis? Why?

A

Ciprofloxacin/Rifampicin - don’t want to breed resistance to ceftriaxone

70
Q

What is the most common viral encephalitis and what is its specific treatment?

A

HSV - IV aciclovir

71
Q

What intracranial infection can result from childhood measles infection?

A

Subacute sclerosing panencephalitis

72
Q

Differentiating between cellulitis and erysipelas?

A

Cellulitis goes deeper (down to deep subcut tissue) and has poorly demarcated borders; erysipelas typically has well demarcated borders and looks like a fiery red rash

73
Q

RFs for cellulitis?

A 
Immunosuppression
Prev cellulitis
Skin lesions incl insect bites and athletes foot
Old age, venous insufficiency, obesity
Alcohol, IVDU
Lymphoedema
74
Q

Differentials for cellulitis/erysipelas?

A 
Necrotising fasciitis
Compartment syndrome
Septic arthritis/osteomyelitis
DVT
Varicose eczema, venous insufficiency 
Vasculitis/thrombophlebitis
75
Q

Usual management of SSTIs?

A

Flucloxacillin to cover GAS, staph

76
Q

What triad is suggestive of primary HIV infection?

A

Fever
Pharyngitis
Rash (palmar plantar?)

77
Q

Pathophysiology behind HIV?

A

Retrovirus which binds to cells with CD4 receptors (T lymphocytes, macrophages, monocytes etc) spread by bloodborne contact (sex, needles etc.)

78
Q

What diagnostic can be used in the acute HIV illness before Ab detection?

A

HIV RNA and p24 antigen

79
Q

What diagnostic screen can be used for established HIV?

A

anti-HIV Abs

80
Q

What is the first stage of illness in HIV?

A

Seroconversion illness few weeks post-infection - may be glandular fever like, with classic triad of fever rash and pharyngitis

81
Q

What follows seroconversion in HIV illness?

A

Asymptomatic infection - slow replication with low viral load, cd4 count relatively unaffected

82
Q

What follows completely asymptomatic infection in HIV and how is it defined?

A

Persistent generalised lymphadenopathy PGL

LNs >1cm in at least 2 non-inguinal sites persistent for at least 3 months with no other cause

83
Q

What symptoms might be experienced in HIV as cd4 count starts to drop, alongside PGL?

A

Constitutional Sx - diarrhoea, weight loss, fever, night sweats
Opportunistic infections - oral hairy leukoplakia, oral thrush, VZV, recurrent HZV, seborrhoeic dermatitis

84
Q

What 2 components are used to stage HIV in the CDC classification?

A

CD4 count and clinical category

85
Q

CD4 divisions used in HIV staging? When is treatment generally started?

A

> 500/mm3 = stage 1
200-499 = stage 2 (treatment when under 350)
Less than 200 = stage 3

86
Q

What is category A in HIV staging?

A

Asymptomatic infection, including seroconversion or PGL

87
Q

What is category B in HIV testing?

A

Symptomatic infection (incl constitutional Sx diarrhoea, fever) or opportunistic infections not meeting category C criteria, incl oral thrush and oral hairy leukoplakia and VZV, ITP

88
Q

What is category C in HIV staging?

A

Presence of at least 1 AIDS defining condition

89
Q

Which CDC classifications of HIV are indicative of AIDS?

A

A3, B3 and C1, C2 and C3

90
Q

Common AIDS defining infections?

A 
Oesophageal candidiasis
TB and other mycobacterium infections incl MAC
Cryptococcal meningitis
Cryptosporidium infection
Pneumocystis jirovecii pneumonia
Histoplasmosis infection
Toxoplasmosis infection (cerebral)
CMV retinitis, unusual EBV or HSV infections
PML
91
Q

Common AIDS defining cancers?

A 
Invasive cervical carcinoma
Burkitts lymphoma (EBV)
Non-hodgkins lymphoma
Neurolymphoma
Kaposi sarcoma
92
Q

Under what 3 circumstances can ART for HIV be started?

A

CD4 under 350
Nervous system involvement
AIDS defining condition

93
Q

Under what circumstances may ART be started for HIV CD4 count between 350-500/mm3?

A

Present or likely CV disease

94
Q

What vaccinations should be given in HIV? What should be avoided?

A

Generally everything possible apart from BCG and VZV

95
Q

6 classes of ART?

A

Nucleoside reverse transcriptase inhibitors
Non-nucleoside reverse transcriptase inhibitors
CCR5 inhibitors
Fusion inhibitors
Protease inhibitors
Integrase inhibitors

96
Q

What type of ART is majorly associated with lipodystrophy syndrome?

A

Protease inhibitors

97
Q

What complication can arise from ART? What is it?

A

Lipodystrophy syndrome - redistribution of fat from subcutaneous to central, increased insulin resistance and dislipidaemia

98
Q

What type of ART should be avoided in concurrent hepatitis?

A

Nucleoside reverse transcriptase inhibitors

99
Q

5 methods for preventing HIV spread?

A 
Safe sexual practises
Needle exchange programmes
Blood screenings for transfusions 
Screening during pregnancy 
Post exposure prophylaxis
100
Q

What is often implicated in acute infective COPD exacerbations? First line Rx?

A

Haemophilus - doxycycline

101
Q

MARRFAW of infectious disease symptoms screen?

A 
Malaise
Arthralgias/myalgias
Rigors
Rash
Fever and night sweats
Appetite
Weight loss
102
Q

TINVAPPS of broad areas of infectious disease RFs to ask about?

A

Travel - ask first and explore where when what who
Infectious contacts/food related
Needles - IVDU, blood transfusion, tattoos, medical Rx abroad
Vaccinations
Previous major infection - BBVs and TB
Sexual Hx if appropriate
Previous hospital admission or indwelling devices
Animals

103
Q

3 criteria for defining PUO?

A

Fever over 38.3 on several occasions over duration of illness
At least 3 weeks of illness
Failure to reach diagnosis after proper investigation at 2 OP visits or 3 days inpatient

104
Q

Common cancers causing PUO?

A

Lymphoma
Leukaemia
Renal cell carcinoma

105
Q

What might be the cause of PUO (and arthralgia, spinal tenderness) in a patient with Hx of cattle/sheep exposure and raw milk products?

A

Brucellosis

106
Q

What characterises oral thrush vs hairy oral leukoplakia?

A

Oral thrush comes off with scraping

107
Q

What causes HIV associated retinitis at CD4 less than 50?

108
Q

Cause of insidious fungal meningitis in HIV patient?

A

Cryptococcus

109
Q

What virus causes HIV associated neurolymphoma?

110
Q

Most common cerebral infection in HIV?

A

Toxoplasmosis

111
Q

How does PCP pneumonia present?

A

Dry cough, SOBOE, night sweats - looks a bit like TB

112
Q

What is the incubation period of gonorrhoea?

A

Up to 2 weeks

113
Q

Rx for HPV?

A

Podophyllotoxin (podophyllin), cryotherapy, electrocautery or excision

114
Q

When does secondary Syphillis infection occur?

A

1-2 months after primary chancre

115
Q

2 features of congenital Syphillis?

A 
Saber tibia
Hutchinsons teeth (have little half moons in them)
116
Q

What criteria is used in defining BV?

A 
Amsel criteria 3/4 of:
Thin white discharge
Clue cells
KOH sniff test
pH over 4.5
117
Q

Incubation and presentation of cholera?

A

3-4 days then abrupt onset severe diarrhoea, going from brown and water to Mucoid fluid alongside dehydration

118
Q

What microscopy findings indicate cholera infection?

A

Comma shaped highly motile gram negative bacteria

119
Q

What is yellow fever?

A

Another flavivirus a bit like dengue but slightly longer incubation
VACCINE!

120
Q

Early Sx of schistosomiasis?

A

Swimmers ish - skin irritation and rash

121
Q

Second stage of schistosomiasis infection?

A

Invasive stage - dry cough, abdo pain, splenomegaly with eosinophilia

122
Q

Chronic schistosomiasis infection?

A

Chronic diarrhoea and hepatomegaly, portal HTN etc.

123
Q

Diagnosis schistosomiasis?

A

PCR serodiagnosis

Ova found in faeces

124
Q

Rx for schistosomiasis?

A

Single dose praziquantel

125
Q

Classical Sx of diphtheria?

A

Grey tough pseudomembrane on pharynx/tonsils

Fever, pharyngitis, mega cervical lymphadenopathy/oedema (Bulls neck sign), stridor, airway compromise

126
Q

Defining features of giardiasis?

A

More common in well sanitised areas

Acute diarrhoea or chronic flatulence, grumbly intestinal Sx and early morning greasy/loose stools

127
Q

3 things that can cause Asplenism?

A

Iatrogenic
SCD
Coeliacs

Revision Qs (28 decks)

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