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Infectious Disease Flashcards

1
Q

Treatment of mild community acquired pneumonia

A

Amoxicillin

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2
Q

Treatment of mod community acquired pneumonia

A

Amoxicillin + clarithromycin

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3
Q

Treatment of severe community acquired pneumonia

A

Co amoxiclav + clarithromycin

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4
Q

Treatment of pneumocystis carinii

A

Co-trimoxazole

- trimethoprim + sulfamethoxazole

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5
Q

TB regimen

A

2 month s- RIPE
4 months - RI

R- rifampicin Isoniazid pyrazinamide ethambutol

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6
Q

Treatment of aspiration pneumonia

A

Amoxicillin + metronidazole

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7
Q

Treatment of meningitis in a GP clinic

A

IV or IM benzylpenicillin

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8
Q

Meningitis tx in hospital

A

Ceftriaxone

If >60 yrs - IV ceftroaxone + amoxicillin

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9
Q

Treatment of listeria meningitis

A

Ceftriazxoen + ampicillin + gentamicin

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10
Q

Meningitis prophylaxis for contacts

A

Cipro = preferred
Or
Rifampin

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11
Q

Treatment on uncomplicated lower UTI in a non pregnant person

A

Trimethoprim or nitrofurantoin

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12
Q

Vulvovaginal candidiasis treatment

A

Clotrimazole or fluconazole

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13
Q

Treatment of trichomoniasis vaginalis

A

Metronidazole

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14
Q

Treatment of bacterial vaginosis

A

Metronidazole

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15
Q

Treatment of cervicitis - chlamydial

A

Chlamydial - doxy 100mg BID fro 7 days

Other

Azithromycin 1g PO
+500mg PO OD for 2 days

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16
Q

Cervicitis tx - gonorrhoeal

A

Ceftriaxone 1g IM single dose

Or
Cipro 500mg PO - single dose

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17
Q

Symphilis treatment

A

Penicillin G

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18
Q

Treatment of genital herpes

A

Acyclovir

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19
Q

Salmonella/shigella/campylobacter

treatment

A

Erythromycin or azithromycin or clarithromycin

Or
Cipro

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20
Q

Pseudomembranous colitis

Treatment

A

Oral metronidazole - 1st line

Vancomycin if severe

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21
Q

Acute otitis media treatment

A

Amoxicillin

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22
Q

Treatment URTI

Pharyngitis/tonsillitis/laryngitis

A

Phenoxymethylpenicillin

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23
Q

Cellulitis / mastitis/ diabetic foot

treatment

A

Flucloxacillin - 1st line

If allergic - clarithromycin , (erythromycin if pregnant) or clindamycin

If MRSA - vancomycin

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24
Q

Septic arthritis / osteomyelitis

Treatment

A

Flucloxacillin + sodium fusidate

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25
Q

Scabies treatment

A

5% permethrin

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26
Q

Toxoplasmosis treatment

A

Pyrimethamine + sulfadiazine

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27
Q

Brucellosis

  • mode of transmission
  • incubation perio d
  • organism
  • areas
A

Bacteria brucellosis
5-30 day incubation period
Inhalation - main mode of transmission
( others : skin/mucous membrane , consumption - untreated mil/dairy , raw meat/liver)
Areas that have high exposure to animals
- Nigeria, s.America , Middle East, centra + south east Asia, Africa

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28
Q

Brucellosis

-symptoms

A

Can be asymptomatic
Fever, arthralgia, malaise, back pain , headache , confiscation , abdominal laundry
Lymphadenopathy, splenomegaly, hepatomegaly
Epididymis-or hit is , skin rash

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29
Q

Diagnosis of brucellosis - initial & gold standard

Treatment

A

Rose Bengal test or serum agglutination
gold - isolation of brucella soo from specimen

Tx - doxycycline + rifampin - 6 weeks

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30
Q

Important association of streptococcal pneumonia

A

Herpes labialis

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31
Q

Erythema multiforme seen in which pneumonia

A

Mycoplasma pneumonia

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32
Q

Pneumonia common in IV drug abusers and elderly

A

Staph aureus

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33
Q

Klebsiella commonly affects what part of lungs

A

Upper lobes - cavitation pneumonia

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34
Q

Pneumonia after flu think -

A

Staph aureus

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35
Q

Pneumonia after hx of exposure to water

A

Legionella

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36
Q

HIV isa risk factor for what types of pneumonia

A

Jirovecii/ Carinii - CD4 <200
Or
Streptococcal

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37
Q

Caseating granuloma in LNS
Sx of fever + cough
Diagnosis

A

TB lymphadenitis

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38
Q

Causes of non caseating granulomas

A

Sarcoidosis

Chronic disease

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39
Q 
Linear tracks (burrows) + severe itching 
Dx?
Organism
Mechanism of itching 
Mode of transmission 
Treatment
A 
Scabies
Sarcoptes scabiei - parasite
Permethrin 5%, NS line - malathion .5%
MOT - skin-skin contact 
Itching - allergic reaction
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40
Q

Glandular fever/ infectious mono
Causative organism
Presentation

A

EBV aka human herpesvirus 4(HHV-4)
Sore throat , exudative tonsillar enlargement, fever, lymphadenopathy
+-Splenomegaly, palatial petechiae, jaundice

imp hint = receiving ampicillin/amoxicillin leads to pruritic maculopapular rash **

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41
Q

Infectious mono
Investigation
Dx
Treatment

A

FBC - raised ESR WBC , lymphocytosis - atypical lymphocytes >20%
Dx - heterophil antibody test - mono spot test - Paul funnel
Treatment - supportive

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42
Q

Risk factors for TB

A

Homeless
Drug abuser
Smoker
Low SE class

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43
Q

1st line investigation for TB

A

Sputum - AFB
If no sputum on cough. - bronchalveolar lavage
^ if refused by patient - gastric lavage

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44
Q

When and how is screening for contacts done in TB

A

Latent (NOT acute ) TB
Mantoux test - if they have not had BCG vaccine before
Interferon gamma test — if they’ve been vaccinated

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45
Q

Directly -observed therapy in TB

A 
For underserved patients 
Homeless, imprisonments 
Drug/alcohol misuse
Non adherent to throat 
Too ill to adhere to rtherapy
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46
Q

Known/suspected TB patients should be __

A

Isolated in negative pressure room

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47
Q

Chronic cough
Tender firm palpable LNS
Erythema nodosum

A

TB

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48
Q

When are gastroenteritis patients safe to return to work in the UK

A

48 hrs after last episode of vomiting/diarrhoea

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49
Q

Delayed complication of bacterial meningitis

A

Hearing loss

** arrange hearing test after treating meningitis!

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50
Q

Kaposi sarcoma
Features
Commonest sites

A

Cancer of connective tissue
Red/purple/brown/black nodules or papules that are usually non painful
Sites- mouth nose throat ( can also grow internally - lungs GIT)

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51
Q

RFs kaposi

A

Homosexual / bisexual
AIDS patient
Jewish/ Mediterranean

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52
Q

Chicken pox

  • organism
  • MOT
  • infectivity
A

Varicella zoster
Mainly airborne but can also be transmitted via direct contact with vesicles (once dried and crusted - no transmission)
Infectivity - 4 days before rash , 5 days after rash

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53
Q

Chicken pox presentation

A

Fever
Itchy rash - macula s > papules> vesicles> dry crust
- starts on face - spreads to chest and back

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54
Q

When can a child w/ chicken pox return to school

A

After vesicles are dry and crusted = 5 days after onset of rash

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55
Q

Chickenpox management

A

<12 - reassure + supportive

If superimposed bacterial infection - discharging pustules, pinkish fluid secreted +_ high fever = oral antibiotics

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56
Q

When to give VZIG? (3)

A
  • immunocompromised puts w/ exposure
  • pregnant w/ exposure and no VZ antibodies
  • newborns with pericardium exposure
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57
Q

When should oral acyclovir be given (2)

A

Immunocompromised patients who develop chicken pox

Pregnant woman who develops chickenpox

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58
Q

Lyme disease - Lymeborreliosis

A

Hx of camping/ walking in gardens/jungles
Erythema migrans
+- fever headache myalgia general aches & pains
Later on - facial paralysis, meningitis, AV heart block, myocarditis, arthritis

Annular rash with scaly edges, slow growing with associated

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59
Q

Most likely diagnostic investigation for meningitis
W/o rash
W/ rash

  • for the exam
A

W/ -blood culture

W/o rash - LP - CSF analysis

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60
Q

Contraindications of LP

A 
Raised ICP
Bulging tense fontanelle
Ongoing seizure
GCS <9 or drop of >= 3
Unequal dilated unresponsive pupils 
Papilloedema
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61
Q

What should be done once there is clinical suspicion of meningitis

A

Notify local health protection team immediately

62
Q

Septicaemia v meningitis

A

Septicaemia (n.meningitidis)
- arthralgia, muscle aches, cold periphery, pale/mottled skin
SOB, rash

Meningitis - photophobia , severe headache, neck stiffness

63
Q

Malaria vs schistosomiasis

A

Schistosoma can’t have hepatomegaly and hematuria at the same time
Mansoni - affects intestines + liver - hepatomegaly
Hematobium - urinary bladder - hematuria, UB calcification, obstructive uropathy

Malaria can have both at the same time

64
Q

Needle stick injury - management

A

1-rinse under running water, wash with soap
Request patients permission to investigate HIV HCV HBV
For pricked health care professional -
-if patient low risk ; test affected HCP for Hep B surface antibody
-pt high risk - start post exposure prophylaxis for affected HCP
-offer hep B booster if not received previously or can’t remember when last received

Return in 6 weeks to be tested for HIV HCV

65
Q

Risk of transmission post needle prick
HIV
HBV
HCV

A

HIV - .3%
HBV - up tp 30%
HCV - 3%

66
Q

Treatment of suspected meningitis with hypersensitivity to penicillin/cephalosporin

A

Chloramphenicol

67
Q

Listeria meningitis - treatment

A

Ceftriaxone + ampicillin + gentamicin

68
Q

Treatment of cryptococcal meningitis

A

Amphotericin B

69
Q

What vaccines should not be given to HIV positive patients

A

BCG
Yellow fever vaccine

If CD4 <200 cells/ml - avoid MMR
<750 in children - avoid MMR

70
Q

Tetanus prophylaxis

A

High risk wound - dirty contaminated / compound fracture

  • not fully immunised - give immunoglobulin
  • fully immunised - no need.

Low risk
- no need

Fully immunised/up2date (5 doses) - don’t vaccinate unless >10 years ago and wound is tetanus prone - give booster
Unknown/incomplete - complete course of tetanus vaccine

71
Q

Course of tetanus vaccine

A

Adults -3 doses 1 month apart, 1st booster after 10yrs , 2nd booster after another 10yrs.

Children - 3 doses 1 month apart, 1st booster after 3 years, 2nd booster 10 years after 1st.

72
Q

Tetanus prone wound

A

Animal bites - strays that dig in soil
Puncture injuries in contaminated area
Compound frx
Wound with foreign body

73
Q

High risk tetanus prone wound

A

Wounds heavily contaminated with soil

Extensive wounds/burns

74
Q

Vaccination unison tetanus

How do you manage

A

Clean - vaccine
Tetanus prone - vaccine + Ig
High risk - vaccine+ig

75
Q

Mumps (paramyxovirus)

  • MOT
  • commonly affects
  • causes the following
  • symptoms
A

Saliva droplets - close contact
Affects salivary glands - mostly parotid
Causes - bilateral parotitis , orchitis
Symptoms - fever dry mouth , difficulty opening mouth

  • orchitis = 4-5 days after parotitis but not always
76
Q

Treatment of mumps

A

Reassurance

Supportive treatment - paracetamol, ibuprofen

77
Q

When is HBsAg +ve ?

A

During acute + chronic infection

78
Q

HBsAg +ve
HBeAg +ve
What does this mean?

A

Highly infectious - active viral replication

eAger to spread

79
Q

What does Anti -HBe indicate?

A

Response to treatment

80
Q

Anti-HBs +ve. =

A

Post vaccination

81
Q

What antibodies are +ve at onset and remain +ve even after treatment

A

Anti-HBc

Indicates past or ongoing infection

82
Q

First marker to be abnormal in Hep B

A

HBsAg - acute /chronic infection

83
Q

High infectivity in Hep B indicated in

84
Q

Recent vaccination in Hep B shown by

85
Q

Past infection of Hep B indicated by

86
Q

IgM anti-HBc indicates

A

Recent ACUTE infection

87
Q

Single non painful genital ulcer

Dx?

A

Syphilis - chancre

88
Q

Multiple painful genital ulcers +- dysuria and flu like symptoms
Dx?
Tx?

A

HSV genital herpes
Acyclovir

*ulcer start off as vesicles

89
Q

Single painful ulcer on genitals

Dx?

A

Hemophilia Ducreyi - chancroid

  • can be multiple but should start as single chancre
90
Q

Multiple painless cauliflower growths

Dx?

A

HPV 6,11 genital warts

91
Q

Haemophilus Ducreyi vs HSV genital herpes

A

HSV - vesicles > ulcers - painful (multiple)

HD - inflamed patches > ulcers (single or multiple)

92
Q

Hx of travel to Far East Asia + fever, headache retro-orbital pain, rash , myalgia
Tender cervical lymphadenopathy
Dx?

A

Dengue fever

93
Q

Tx of travel to India + flu like symptoms
Enlarged anterion LN s
Grey membranes on tonsils

A

Diphtheria

94
Q

Hx of travel to South America + sever headache + patient in crouching position

95
Q

High fever + watery diarrhoea + headache + myalgia
Later followed by bloody diarrhoea
Organism responsible?
Treatment

A

Campylobacter jejuni
1- macrolides - erythromycin, azithromycin, clarithromycin
2-cipro

96
Q

Red eyes followed by yellow eyes afte hx o travel and water exposure
+ fever, rigours, malaise , arthralgia, myalgia
Dx?
Investigations
What is done to confirm the dx?

A

Leptospirosis
- blood & urine C&S
Confirm - serology

Organism detectable in blood first 7-10 day s
In uterine 7-30 days

97
Q

Test for definitive diagnosis of malaria

A

Think + thick blood film for microscopy

98
Q

Organism responsible for travellers diarrhoea

A

E.coli

Diarrhoea - 72 hrs (short period & self limited )

99
Q 
Watery diarrhoea + weight loss + abdominal pain 
Doul smelling flatulence, bloating 
Dx?
1st line investigation 
1st line treatment
A

Giardiasis

  • stool microscopy - ova parasite
  • metronidazole + hygiene
100
Q

HIV Post exposure prophylaxis

A

Anti retro viral meds ASAP after exposure to high risk
1-72 hrs after exposure
1st line - Truvada & Raltegravir - 28 days
F/u HIV testing - 8-12 weeks after exposure

All human bites - treat coamoxiclav PO 7 days if allergic - metro +doxy

101
Q

When can you reassure the contact person of HIV

A

Antiretrovirals >= 6 months

And HIV viral load <200

102
Q

Shingles in immunocompromised individual
Next step
Management

A

Obtain serology for varicella immunity

  • if +ve (immune) - reassure
  • if -ve (not immune) - give VZIG
103
Q

Shingles treatment

104
Q

Ramsay hunt syndrome
Symptoms
Treatment

A

Herpes zoster Oticus

  • facial nerve palsy - ipsitalateral, loss of taste ant 2/3
  • otalgia - st symptom - tinnitus, vertigo, UHL

T - oral acyclovir r+ corticosteroids +amitriptyline

105
Q

Herpes zoster ophthalmicus
Symptoms
treatment

A

In ophtlamic branch of trigeminal
Conjunctivitis keratitis painful vesicles around eye
Acyclovir

106
Q

Annular rash w/ scaly edges on thigh + genera pains and aches
Likely Dx?
Appropriate investigation
1st line treatment

A

Lyme disease
- antibodies to Borrelia burgdorferi
1st line treatment - Doxycycline (if pregnancy - amoxicillin)

107
Q

Cerebral toxoplasmosis

  • symptoms
  • causative organism
  • reactivation
A

Raised ICP - headache eye pain seizures, focal neurological deficits, confusion
Visual hallucination, facial weakness
Org- toxoplasma Gondi (lives and reproduces in cat guts)
Reactivate din HIV (CD4<100)

108
Q

Imaging for cerebral toxoplasmosis

Treatment

A

MRI w/ contrast brain - Ring enhancing lesions

Pyrimethamine + sulfadiazine

109
Q

Anti malarial treatment

A

Latent phase/ dormant - primaquine (ovals/vivax)
Ovale/vivax ^ = ring form plasmodium w/ schuffners dots in RBCS / latent hypnozoites in liver

Non falciparum/ non hypnozoite malaria - chloroquine (targets active stage)
- if fails - quinine

Pregnant - mefloquine

110
Q

Contraindication of primaquine

A

G6PD

Pregnancy, breastfeeding

111
Q

Neutropenia sepsis (febrile neutropenia)

A

Neutrophils <= 0.5x10^9
Fever >= 38.5 or x2 seen above >38

Usually happens after chemo or within 1 year from BM transplant

112
Q

Management of neutropenia sepsis

A

IV ABx - empirical - start immediate;lay
= IV Tazocin ( taco act am + piperacillin)

If still febrile after 48 h r- try meropenem +- vanco

If after 4-6 days still unwell - investigate a fungal infection - IV antifungal

113
Q

Treatment of leptospirosis

A

Usually mild and self limited
Mild - oral doxy
Severe - ampicillin or benzyl penicillin

114
Q

Doxycycline used to treat (3)

A

Leptospirosis
Lyme disease
Chlamydial cervicitis

CI in pregnancy - amoxicillin instead

115
Q

Necrotising fasciitis
Risk factors
Symptoms

A

IM or SC drug injections / DM / immunosuppression

Initially resembles cellulitis with no response to flucloxacillin
- then bullseye > grey/black sin - septic shock
Very severe pain out of proportion to physical signs

116
Q

Treatment of necrotising fasciitis

A

Urgent surgical debris event

IV antibiotics - clindamycin/ benzyl penicillin

117
Q

Necrotising fasciitis vs erysipelas

A

Erysipelas - well demarcated

NF - diffuse and deep

118
Q

Cerebral malaria vs meningitis

A

Anemia points more towards cerebral malaria

119
Q

ABx prophylaxis in HIV

A

CD4 < 200 - cotrimoxazole (against P.J)

CD4 < 50 - azithromycin ( mycobacterium avium )

120
Q

Red flags for sepsis (6)

A 
SBP <9-
HR >130 
RR >= 25
UO < .5ml/kg/hr 
Lactate >= 2 mmol/l
Recent chemo
121
Q

Whipples disease

  • organism
  • common in
  • features
A

Tropheryma Whippelii - Rare multisystem disease
HLA B 27 +ve & middle aged men

Malabsorption* - diarrhoea + weight loss
Large joint arthralgia, lymphadenopathy 
Pleurisy, pericarditis 
Neuro - o.plegia, dementia , ataxia , seizures 
Hyperpigmentation + photosensitive
122
Q

Whipples disease

Investigation
Treatment

A

Jejunal biopsy - stunted villi + macrophage deposition containing PAS (periodic acid -Schaffer) granules **** diagnostic

Guidelines vary : oral cotrimoxazole 1 year - lowest relapse rat e
- sometime preceded by IV penicillin

123
Q

Whipples disease vs celiac disease

A

Jejunal biopsy -
WD = macrophages with PAS granules
CD - villus atrophy, crypt hyperplasia , lymphocytosis

124
Q

Patient with known celiac disease - duodenal biopsy shows lymphomatous infiltrates

A
  • Lymphoma

T cell lymphoma is a rare complication of celiac disease

125
Q

Most common organism causing mastitis

126
Q

Safe antidepressant in breastfeeding

A

Sertraline

- also SSRi of choice in hx of MI

127
Q

HCV antibody indicates

A

If patient has ever been exposed to HCV

128
Q

HCV RNA suggests

A

Current Hep C infection

129
Q

Anti-TB drug avoided in pregnancy

A

Streptomycin

130
Q

Side effects of isoniazid

A

INH = peripheral neuritis , hepatitis , SLE

- give vit B6

131
Q

Side effects of rifampin

A

Red orange urine

P450 induction

132
Q

Side effects of pyrazinamide

A

Raises uric acid - gout

133
Q

Side effects of ethambutol

A

Eye problems
- red green discrimination
Optic neuritis and decreased visual acuity

134
Q

Side effects of streptomycin

A

CI in pregnancy

Ototoxic

135
Q

Travellers diarrhoea

Salmonella vs shigella

A

Both are main causes
Treatment
Cipro 1st for salmonella
Shigella - macrolides , cipro

136
Q

Treatment of oral thrush

A

Oral fluconazole 50mg OD - 7 days or fluconazole oral suspension

If infection is mild and localised - miconazole gel 1st line

137
Q

Most likely involved organ in infectious mono

138
Q

Investigation of HSV

A

1st line. - NAAT testing
Other - viral culture + DNA PCR

If negative or recurrent - anti HSV antibody

139
Q

Investigation of syphilis

A

Penile ulcer present -
dark field microscopy in GU clinic
PCR in GP clinic

If penile/mouth ulcer both healed -
Serology for syphilis

140
Q

Fibrin web in CSF

A

TB meningitis

141
Q

Turbid or cloudy CSF on LP

A

Bacterial meningitis

142
Q

Neisseria meningitidis vs strept meningitis

A

Turbid CSF ONLY - strept

Turbid CSF + rash - n.meningitis

143
Q

Classification of osteomyelitis

A

Haematogenous

Non hematogenous

144
Q

Haematogenous osteomyelitis

  • cause
  • common in
  • what the most common form in adults
  • RFs
A 
Haematogenous - 
- bacteremia, usually monomicrobial 
Most common form in children 
Vertebral most common site in adults 
RFs - SCA, IV drug user, immuno suppression , infective endocarditis
145
Q

Non - haemotogenous
- cause
- common in
RFs

A

From contiguous spread from adj soft tissue
Polymicrobial
RF - diabetic foot ulcers, pressure sores, DM , PAD

146
Q

Most common organism causing osteomyelitis

A

Staph aureus

Except SCA - salmonella

147
Q

Investigation of choice in osteomyelitis

A

MRI

90-100% sensitivity

148
Q

Antibiotics that can cause pseudomembranous colitis

A 
Clindamycin
Amoxicillin
Ampicillin 
Co-amoxiclav 
Cephalosporin 
Quinolones - cipro
149
Q

Investigation of p.colitis

Treatment

A

CDT toxin in stool

Tx -
1 -oral metronidazole
2- oral vancomycin

  • c.difficile can easily spread to others
150
Q

Hep C work up

A

Initial test - HCV antibody
To confirm active infection - HCV RNA PCR
- if negative - repeat in 6 months
If hep C confirmed to pick antiviral regimen - HCV genotype test

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