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Fourth > Infectious disease > Flashcards

Infectious disease Flashcards

1
Q

What organism causes necrotising fasciitis?

A

Type 1 is caused by mixed anaerobes and aerobes (often occurs post-surgery in diabetics). This is the most common type

Type 2 is caused by Streptococcus pyogenes

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2
Q

What is the management of necrotising fasciitis?

A

urgent surgical referral debridement

intravenous antibiotics

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3
Q

What is the typical presentation of mumps?

A

Fever
Malaise, muscular pain
parotitis (earache, pain on eating): unilateral initially then becomes bilateral in 70%

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4
Q

What are the complications of mumps?

A
  • Orchitis - uncommon in pre-pubertal males but occurs in around 25-35% of post-pubertal males. Typically occurs four or five days after the start of parotitis
  • Hearing loss - usually unilateral and transient
  • Meningoencephalitis
  • Pancreatitis
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5
Q

What is the Amsel’s criteria for bacterial vaginosis?

A

Amsel’s criteria for diagnosis of BV - 3 of the following 4 points should be present

  • 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)
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6
Q

What is the treatment for BV?

A

Oral metronidazole:400–500 mg twice daily for 5–7 days

topical metronidazole or topical clindamycin are alternatives

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7
Q

How do you differentiate BV from Trichomonas?

A

BV - Thin, white discharge with clue cells on microscopy

Trichomonas - Frothy, yellow-green discharge, vulvoagniitis, strawberry cervix

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8
Q

A 29-year-old woman who is 10 weeks pregnant presents to her GP with a rash over her right thigh. Her observations are normal and she appears well in herself otherwise. It appears to be cellulitic and the GP decides to prescribe her some antibiotics to target the cellulitis. She is penicillin allergic.

Which antibiotic is appropriate to cover for this infection?

A

Erythromycin

Usually flucloxiciilin - but if not usable - then clarithromycin if not pregnant

Doxycycline can also be used
Severe - co-amoxiclav, cefuroxime, clindamycin and ceftriaxone can be used

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9
Q

What is the criteria for admission for cellulitis?

A
  • Has Eron Class III or Class IV cellulitis.
  • Has severe or rapidly deteriorating cellulitis (for example extensive areas of skin).
  • Is very young (under 1 year of age) or frail.
  • Is immunocompromized.
  • Has significant lymphoedema.
  • Has facial cellulitis (unless very mild) or periorbital cellulitis.
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10
Q

What are the risk factors for invasive aspergillosis?

A

Risk factors include:

  • HIV
  • Leukaemia
  • Following broad-spectrum antibiotics
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11
Q

What are the notable adverse effects of tetracyclines?

A
  • Discolouration of teeth: therefore should not be used in children < 12 years of age
  • Photosensitivity
  • Angioedema
  • Black hairy tongue
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12
Q

What are the different incubation periods of bugs causing diarrhoea?

A

1-6 hrs: Staphylococcus aureus, Bacillus cereus*
12-48 hrs: Salmonella, Escherichia coli
48-72 hrs: Shigella, Campylobacter
> 7 days: Giardiasis, Amoebiasis

*vomiting subtype, the diarrhoeal illness has an incubation period of 6-14 hours

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13
Q

A 32-year-old female patient attends your practice complaining of severe frontal facial pain, fever, and rhinorrhoea. This has been ongoing for nearly two weeks and she is now feeling more unwell. She has tried over the counter nasal sprays but with no effect.

Her observations are:
Temperature: 38.1ºC
Pulse: 96 bpm
Blood pressure:118/80 mm/Hg

She asks you to prescribe some antibiotics to help with her symptoms, she has no known allergies.

Which of the following would be your first-line choice?

A

Phenoxymethylpenicillin

This is a case of sinusitis. Sinusitis is usually caused by viral infections and therefore treatment is not usually indicated if symptoms are present for less than 10 days. Beyond this, steroid nasal sprays are usually the first-line treatment, unless antibiotics are indicated.

In this case, her symptoms have been present for nearly two weeks. Her fever and slightly raised heart rate are consistent with her being unwell and would therefore be indications for antibiotics in this case.

In acute uncomplicated sinusitis, first-line therapy as per NICE guidelines would be phenoxymethylpenicillin. In those who are penicillin-allergic, doxycycline or clarithromycin can be used.

The second-line choice would normally be co-amoxiclav.

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14
Q

A 42-year-old male attends your practice complaining of a two-day history of pain ‘down below’. He has been suffering from urinary frequency and nocturia. Digital rectal examination reveals a tender, boggy prostate.

How would you manage him in the first instance alongside painkillers?

A

This is a case of acute prostatitis, which can be quite distressing to patients. This should be treated with a 14-day course of ciprofloxacin 500mg BD and reviewed thereafter as a further two-week course may be required.

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15
Q

What is the treatment for MRSA?

A

vancomycin
teicoplanin
linezolid

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16
Q

What can be used to suppress MRSA once a carrier is identified?

A

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

Skin: chlorhexidine gluconate, od for 5 days. Apply all over but particularly to the axilla, groin and perineum

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17
Q

What is the source of clostridium tetani?

A

Tetanus spores are present in soil and may be introduced through a wound

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18
Q

What are the features of tetanus infection?

A
  • prodrome fever, lethargy, headache
  • trismus (lockjaw)
  • risus sardonicus
  • opisthotonus (arched back, hyperextended neck)
  • spasms (e.g. dysphagia)
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19
Q

what is the treatment for gonorrhoea?

A

IM ceftriaxone

if ceftriaxone refused - oral cefixime + oral azithromycin should be used

20
Q

what are the complications of hep B?

A
  1. chronic hepatitis
  2. hepatocellular carcinoma
  3. glomerulonephritis
  4. polyarteritis nodosa
  5. cryoglobulinaemia
21
Q

what are the features of a legionella infection?

A
  • fever
  • dry cough
  • relative bradycardia
  • confusion
  • lymphopaenia
  • hyponatraemia
  • deranged liver function tests

lymphopenia, deranged LFTs

22
Q

what are the risk factors for necrotising fasciitis?

A
  • skin factors - recent trauma, burns or soft tissue infections
  • diabetes mellitus - particualrly if pt treated with SGLT2 inhibitors
  • IV drug use
  • immunosupression
23
Q

what is the management if the pt has had a full course of tetanus vaccines with the last dose in the < 10 yrs ago?

A

supportive treatment

24
Q

what is the management if the pt has had a full course of tetanus vaccines with the last dose in the > 10 yrs ago?

A

tetanus prone wound: reinforcing dose of vaccine

high-risk wounds - reinforcing dose of vaccine + tetanus IG

25
Q

what is the mx of pt who has incomplete or unknown tetanus vaccine history?

A
  • reinforcing vaccine - regardless of severity

for prone or high-risk wounds - reinforcing dose of vaccine + tetanus IG

26
Q

what is the mx of MRSA?

A

nose - mupirocin 2% tds for 5 days

skin: chlorhexidine gluconate OD for 5 days

27
Q

how do you differentiate chancroid, lymphogranulum venerum and syphilis?

A

Painless ulcer and painless lymphadenopathy= Syphilis
Painless ulcer and painful lymphadenopathy= LGV
Painful ulcer and painful lymphadenopathy= Chancroid

28
Q

what are the features of leptospirosis?

A

LEPtospirosis

Legs - bilateral calf pains
Eyes - bilateral conjunctivitis
Pyrexia

29
Q

what is the cause of leptospirosis?

A

leptospira interrogans

30
Q

what is the tx for leptospirosis?

A

high dose benzylpenicillin or doxycycline

31
Q

what is the commonest cauase of pneumonia in alcoholics?

A

klebsiella pneumonia

club- siella

32
Q

what abx is given prophylactically in pts with human bites?

A

Co-amoxiclav

33
Q

what is the tx for LGV?

A

doxycycline

34
Q

what is the Ix for suspected giardiasis?

A

stool microscopy for trophozoite and cysts

stool antigen detection assay

35
Q

what is the tz for giardiasis?

A

metronidazole

36
Q

what is the tx for taxoplasmosis?

A

No treatment is usually required unless the patient has a severe infection or is immunosuppressed.

37
Q

what are the two types of trypanosomiasis?

A
  1. african trypanosomiasis - sleeping sickness

2. american trypanosomiasis - chagas disease

38
Q

what are the features of african tyrpanosomiasis or sleeping sickness? and what is the tx?

A
  • Trypanosoma chancre - painless subcutaneous nodule at site of infection
  • intermittent fever
  • enlargement of posterior cervical lymph nodes

later: central nervous system involvement e.g. somnolence, headaches, mood changes, meningoencephalitis

39
Q

what are the features of american tyrpanosomiasis or Chagas disease?

A
  • myocarditis may lead to dilated cardiomyopathy (with apical atophy) and arrhythmias
  • gastrointestinal features includes megaoesophagus and megacolon causing dysphagia and constipation

azole or nitroderivatives such as benznidazole or nifurtimox

40
Q

what is the Ix and Tx for taxoplasmosis for immunocomprmised patients?

A

pyrimethamine plus sulphadiazine for at least 6 weeks

41
Q

what are the infective causes of bloody diarrhoea?

A 
Yersinia 
shigella
Histolitica (entoemoeba)
E coli
salmonella
campylobacter
42
Q

what are the live attenuated vaccines?

A 
BCG
measles, mumps, rubella (MMR)
influenza (intranasal)
oral rotavirus
oral polio
yellow fever
oral typhoid
43
Q

20 y old with SOB, high temp and sore throat. started on abx but did not finish. presents with bilateral infiltrates on CXR and CT chest showed likely multiple septic emboli and later a CT neck with contrast showed a thrombus in the right internal jugular vein. what is the dx?

A

Lemierre’s syndrome

An infectious thrombophlebitis of the internal jugular vein - secondary to tonsillitis
A combination of spread of the infection laterally from the abscess and compression lead to thrombosis of the IJV.

44
Q

what is the cause of dengue?

A

dengue virus - genus flavivirus

45
Q

what are the features of typhoid infection?

A

maculopapular rash
abdo pain
dysentry

46
Q

what are the features of dengue?

A 
Fever
retro-orbital headache
myalgia, bone ppain and arthralgia
pleurtic pain
facial flushing
warning signs - abdo pain, hepatomegaly, persistent vomiting

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