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MRCP PART 1 > Infectious disease > Flashcards

Infectious disease Flashcards

1
Q

What causes lime disease? How does it present? Ix? Rx? Most common chonic issue

A

Borrelia bugdorferi
Erythema target rash (circular often with bulls eye)

Borriella IgG (IgM will disappear after 6 months - both become detectable after about 6 weeks)
Abx eg doxy / amox for 3 weeks

Chronic arthritis [most common], neurological Sx, cardiac etc…

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2
Q

Leigonella presentation? If this presentation in a child? Diagnostic test ? Abx of choice?

A

Pneumonia
+Confusion, GI/renal/liver issues, HypoNa
Travel to Med (clusters of cases)

Consider mycoplasma in a child

Urinary antigen

marcrolide -Mycins Eg Clari
fluoroquinolones - eg levofloxacin

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3
Q

CSF in viral encephalitis

A

Normal protein / glucose
Lymphocyte predominant
Clear in colour

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4
Q

What causes mumps

A

paramyxovirus

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5
Q

Scattered clusters of vesicular rash -> shortness of breath and cough…Diagnosis? Rx? Other common complications

A

Varicella zoster - chicken pox
Aciclovir (+immunoglobulin if needed)

Encephalitis / hepatitis / pneumonia

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6
Q

3 bugs you are at risk of with hyposplepnism

A

Pneumococcal
N meningitides
H influenzae type B

[vaccines and lifelong peniciln)

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7
Q

TB meningitis length of treatment

A

12 months
+ 2 months steroids
[pulm TB is 6 months]

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8
Q

CNS CMV infection treatment if immunocompromised

A

Ganciclovir

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9
Q

Encephalitis MRI Pick up of:
Herpes simplex
Varicella zoster
CMV

A

Harold takes very odd climbing decisions

HSV - Temporal
VSV - Occipital
CMV - Deep white matter

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10
Q

Visceral Leishmaniasis. Ix to make a diagnosis? Vector? Rx?

A

Biopsy Eg. Bone marrow aspirate/spleen / lymph nodes

Sandfly

Liposomal amphotericin B

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11
Q

Cutaenous leishimaniais presentation? Dx? Management?

A

Ulcer
Skin biopsy
Sodium stilbogluconate

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12
Q

Asymptomatic UTI in pregnancy treatment

A

Treat - Eg nitro/amox

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13
Q

Name 3 times you would treat asymptomatic bacteriuria

A

Pregnancy
before an invasive urological procedure
Immunocompromised

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14
Q

Bacterial vaginosis. Which commensal microbe is usually replaced?

A

Lactobacilli (replaced by anerobes)

[think lacto = breast milk]

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15
Q

Malaria which mosquito? Which is the severe one? Diagnosis?

A

female anopheles
Plasmodium falciparum
[all plasmodiums]

Serial Thick and thin blood film

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16
Q

Malaria is key differential in anyone whos just been to Africa + abdo tenderness / neurological Sx and fever. What if they also have a rash

A

malaria-like + rash = DENGUE

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17
Q

If ELISA tests (IgM/IgG) negative for lime disease how do you test?

A

Repeat ELISA after 4 weeks
Immunoblot if >12 weeks

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18
Q

What is a Jarisch Herxheimer reaction

A

Reaction following Abx Rx of lime disease.

[Thought to be from bacterial cell death -> fever / myalgia / headache
Should spontaneously recover ]

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19
Q

Diagnosis of gonorrhoea? Rx? Follow up?

A

NAAT testing
IM cef
Follow up in 1 week to check sx resolution + test of cure

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20
Q

What is Fitz-hugh-curtis syndrome

A

peri-Hepatic abscess in gonorrhoea

[Fitz Hugh and curtis all have gonorrhea ]

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21
Q

3 most common bugs for immunocompromised bacterial meningitis

A

N meningitidies, Strep Pneumo, Listeria monocytogenes
[+ gram neg bacilli)

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22
Q

listeria abx? Where do you catch listeria? Who gets serious listeria bar immunocompromised?

A

Febrile gastroenteritis - amox / co-trimox
Systemic / CNS - Ampicillin
[Most non immunocompromised do not require Rx]

Food poisoning

Neonates -> CNS infection as in immunocompromised

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23
Q

Most common cause of pneumonia

A

Strep pneumo

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24
Q

Erythema multiform in which common bacteria

A

Mycoplasma pneumonia

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25
Q

Blood markers of severe pneumonia

A

Positive blood cultures
PO2 <8 despite O2
Multilobar
WCC <4.3 OR >20.3
Hypoalbuminaemia

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26
Q

Rx of P. Falicparum

A

Artemether and lumefantrine

If severe - IV artesunate

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27
Q

Where do malarial sporozites replicate? What causes jaundice in malaria?

A

In the liver
After replicating -> bloodstream and infect RBCs causing intermittent haemolysis, fevers and jaundice

[RBC lysis releases more malria into blood -> enter cycle]

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28
Q

What is algid malaria ?

A

Malaria + gram negative sepsis [bad]

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29
Q

What is the thick and thin blood film for in malaria

A

Thick - identidy if infection
Thin - identify species

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30
Q

Severe malaria features
4 things found on ABG?

A

Hb <50
Hypoglycaemia <2.2
Ph <7.3
Lactate >5

Conciousness
Shock
Haemoglobinuria (blackwater fever)
Oliguria

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31
Q

Which malaria if severe anaemia, SPLENIC RUPTURE, and AKI?

A

P Vivax

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32
Q

Usual Rx of typhoid (salmonella)

A

Ceftriaxone / cefiximine
[or Fluoroquinolone]

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33
Q

How does salmonella get into blood?

A

Through Peyers patch in distal ileum -> reticuloendothelial system (liver, spleen, marrow)

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34
Q

Salmonella incubation period

A

12-72 hrs

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35
Q

Salmonella infection usually lasts 3 weeks. Week 1 has lots of vauge symtoms eg fever and what bowel?
Week 2 - what rash? type of diarrhoea? Other Sx?

A

Usually constipation

Rose spots (erythematous maculopapular on chest/abdo)
‘pea soup’ diarrhoea
Splenomegally + neuro Sx

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36
Q

Salmonella usually diagosed with blood / stool cultures

How to differentiate s.typhi or s.parathypi

A

Widal’s agglutination test

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37
Q

Work on a farm -> incubation
headaches, fevers, dry cough, endocarditis, derranged LFTS and hepatosplenomegaly ? Diagnosis? Rx?

A

Q fever - Coxiella burnetti
Doxy

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38
Q

Q fever in preganacy Rx

A

5 weeks co-trimoxazole

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39
Q

tic bite -> not lime disease? and develops maculapaular rash where? Rx?
What if in migrant camp?

A

Either tick-borne replapsing fever OR
Rocky mountain spotted fever

Everywhere including palms and soles -> becomes petechial

Doxy [or cloramphenicol]

typhus fever if in migrant camp

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40
Q

HIV when do you prescribe PCP prophylaxis?

A

When CD4 < 200 [co-trimoxazole]
Or if have had previous treatment for PCP

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41
Q

Which malarias may return after initial infection?

A

vivax and ovale

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42
Q

Atovaquone and proguanil is?

A

Malarone

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43
Q

Cultivation of (for diagnosis of):
Nocardia ssp
Chlamydia
Mycobacterium leprae

A

Nocardia ssp - parafin
Chlamydia - cell cutlture
Mycobacterium leprae - mouse foot pad innoculation

ssP - Parafin
C-C
M - M

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44
Q

Worldwide most common cause of iron deficinecy anaemia?

A

Hookworm

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45
Q

Usual means of infection of hookworm? Basic pathogenesis? present? Key finding on routine Ix? Dx? ?Rx?

A

Through walking barefoot
->Intesnse local itching
->go through lungs (may cause Sx)
->goes into gut - attaches to eppithelium and slowly causes blood loss

Present with symtoms of anaemia + vauge abdo symtoms

Eosinophillia

Stool sample for ova

Albendazole

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46
Q

Topical podophyllotoxin /imiquinod used in

A

Extensive genital warts / anal warts [need to check HIV for extensive disease- as likely immunocompromised]

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47
Q

There are over 100 types of HPV
Which in anal warts and the most common vag warts?
Which causes cervical Ca? Oropharyngeal Ca

A

Anal - 6 and 11
Ca - 16 and 18 [16 in oral Ca]

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48
Q

Who gets a yearly smear test?

A

HIV

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49
Q

Usual treatment of cutaneous HPV

A

Weekly paring (basically filing them down)
+ salycilic acid

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50
Q

PEP for HIV… Just need to recognise it

A

Tenofovir/Emtricitabine (Truvada ®) + Ritonavir

Tenofovir/Emtricitabine (Truvada ®) + Lopinavir

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51
Q

HIV 1 vs HIV 2 distribution

A

1 - Worldwide
2 - only in west africa really

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52
Q

In the first 3 months after infection HIV might not be detected giving false negative results. What can you test for? Tests for HIV activity longer term?

A

HIV RNA + p24 antigen

HIV RNA (viral load) and CD4 count for markers of disease

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53
Q

HAART involves how many drugs? classes?

A

Minimum 3
Nucleosise reverse transcriptase inhibitors
Protease inhibots
Integrase inhibitors

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54
Q

Cat scratch fever
Scratch -> lymphadenopathy
Caused by?

A

Bartonella henselae

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55
Q

Bartonella henselae vs bartonella quintana

A

Henselae - cat scratch fever

Quintana - from human louse infection -> trench fever eg in displaced populations

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56
Q

How does denge present

A

repeated biphasic ‘sadlleback’
Fever, chills, retro orbital headache and a widespread maculopapular rash

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57
Q

When do you get rose spots ? what are they?

A

Typhoid fever - salmonella

Pink blanching macules on trunk

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58
Q

Constipation and a parodoxical relative brady?

A

Salmonella

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59
Q

Returning traveller with macuolpapular rash what things are we considering ?
Urticarial rash?

A

Dengue
HIV seroconversion
Zika
Chikungunya

Urticarial - shisto

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60
Q

Black eschlars (necrotic tissue on top of ulcer) on skin seen in

A

Scrub typhus
Cutaneous anthrax (often IVDU)

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61
Q

Rickettsal infection Rx? If pregnant?

A

Doxy

Chloramphenicol if preh

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62
Q

How to differentiate HBV immunity from past infection and from immunisation

A

Past infection will have Core antibodies and surface antibodies

Immunise only uses surface antigen -> only surface antibodies

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63
Q

Whats the small lung leison in TB called? How do the bacteria get about

A

Ghon focus

Through lymphatics

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64
Q

TB culture requres 3 samples (one early morning ). Test for Test for Acid fast bacilli usuing zeihl-neilson or which other stain?
After this…?

Faster way to get a diagnosis if pt is acutely unwell?

A

Auramine

Cultured on lo-wenstein-jensen medium for at least 6 weeks.

TB PCR

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65
Q

HIV + pleural effusion usually

A

TB
PCP more just pneumo for exam

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66
Q

When is a mantoux test for TB positive? How to detect response of white cells to TB antigens?

A

if it is >5mm after 2-3 days

interferon gamma release assay

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67
Q

Length of drugs in TB

A

RI = 6 months
PE - 2 months

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68
Q

When is a smear positive patient with TB considered non-infective

A

Following 2 weeks of tb chemo (RIPE)

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69
Q

Which TB drug causes optic neuritis / reduced acuity)

A

Ethambutol

[Eye]

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70
Q

Which TB drug gives peripheral neuropathy? Drug to prevent this given to Eg alcoholics/diabetes/renal failure

A

Isonazid

Can give pyridoxine

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71
Q

Red/dark yellow urine with TB drugs?

A

Rifampacin

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72
Q

What is potts disease

A

Crush fracture of thoracic spine due to TB osteomyelitis

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73
Q

Approx intervals between exposure to … and diarrhoea sx?
S aureus
C botulinum
Salmonella
V colera

A

S aureus 1-6 hours
C botulinum 12-36hrs [plus weakness]
Salmonella 12-48hrs
V colera 1-5 days

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74
Q

Most common cause of IE?

A

S AUREUS

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75
Q

Whooping cough bug? Usual Rx?

A

Bordetella pertussis
Erythromycin

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76
Q

Toxoplasmosis CNS infection on CT

A

Ring enhancing lesions

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77
Q

Where is the host of toxoplasmosis . How many people in UK infected? Usual method of transmission?

A

intestines of cats

Incidence of about 25% [90% asymptomatic]

Eating undercooked meat [not cat meat lol]

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78
Q

Toxoplasmosis usally asymotomatic and no treatment. If treatment is required, its usually a combination including? Drug to prevent vertical transmission?

A

Pyrimethamine

Spiramycin

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79
Q

STI in traveller with painful rugged ulcer + lymph node swelling
Gram negative rod?
Bug name?
Rx?

A

chancroid
haemophylis ducreyi

Single does Oral azithromycin / cef IM

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80
Q

How does primary syphilis present

A

painless clean ulcer

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81
Q

Staph vs strep down a microscope

A

Both gram positive coccus

Staph - clusters
strep - chains/ pairs

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82
Q

STI gram negative diplococci is

A

Gonorrhoea

Not chlamydia

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83
Q

What are koplik’s spots? Pathognomonic of

A

White papules with erythematous base in oral mucosa

Measles

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84
Q

Mealses presentation ? Bug?

A

Flu like + conjunctivitis
-> rash usually starting behind ears
[koplik spots in mouth]

RNA Morbillivirus

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85
Q

‘slapped check’ syndrome caused by?

A

Parovirus b19

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86
Q

Syphilis caused by ?
primary vs secondary? Where is rash

A

Treponema pallidum
Primary - painless ulcer

Secondary - maculopapular rash on palms / soles, genital ulcers (Condylomata lata), snail tract lesions in oral mucosa, lymphadenopathy

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87
Q

Fit and well asymptomatic bacteruria - would you repeat it?

A

NO

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88
Q

Wuchereria bancrofti causes

A

lymphatic filiarasis

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89
Q

Blood transfusion in UK
3 Weeks later - pharyngitis / lymphadenopathy and mild derranged LFTs

A

CMV
(Hep viruses screened - CMV is not unless blood for immunocompromised )

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90
Q

Fever, severe pharyngitis, neck swelling + significant lymphadenopathy. Raw meat in history

A

Oropharyngeal anthranx considered

Usually has an inflammatory lesion which goes on to ulcerate / necrosis

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91
Q

Anthrax usual place infected? How does this present

A

95% cutaneous

Purple infected papule -> vesicle -> ulcerates -> black eschar

[consider this especially if from an injection site in IVDU]

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92
Q

SEX then 2-4 weeks later
Fever, myalgia, tender cervical lymphadenopathy, Erythematous maculopapular rash

A

HIV seroconversion

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93
Q

Severe cellulitis and pen allergic. First line? When would you use vanc?

A

Clinda usually - also switches off bacterial toxin production

Vanc if MRSA

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94
Q

Differentiate erysipelas and cellulitis

A

erysipelas - raised and well differentiated border
[superficial whereas cellulitis involves sub cut tissue]

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95
Q

Cellulitis usually S aureus / Strep pyogenes. Triggers from question…
Hot tubs, sponges, nail puncture

A

Pseudomonas

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96
Q

Cellulitis usually S aureus / Strep pyogenes. Triggers from question…
saltwater
freshwater

A

Salt water - vibrio vulnificus
[Vulfunucus sound you make tryna swim in waves]

Fresh - Aeromonas hydrophilia
[Fresh aer water]

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97
Q

Cellulitis usually S aureus / Strep pyogenes. Triggers from question…
Butchers, vets, fishmongers

A

Erysipelothirx rhusiopathiae

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98
Q

Cellulitis usually S aureus / Strep pyogenes. Triggers from question…
Aquarium handlers

A

mycobacterium marinium

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99
Q

Cellulitis usually S aureus / Strep pyogenes. Triggers from question…
Cat/dog bite

A

Pasteurella multocida
capnocytophaga canimorsus

[senior pascal, the Ca[p]t

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100
Q

Cellulitis usually S aureus / Strep pyogenes. Triggers from question…
human bite

A

eikenella corrodens

[Eik a human bit me]

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101
Q

Cellulitis usually S aureus / Strep pyogenes. Triggers from question…
rodent

A

streptobacillus moniliformis

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102
Q

What is a furuncle ? carbuncle

A

Painful lump filled with pus

Same but bigger

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103
Q

Which E coli most common for infant diarrhoea ?
Community / travellers diarrhoea?
Dysentery ?

A

EPEC -P Peads
ETEC - T travel

EIEC - I invasive
EHEC (0157)- Oh HEC its 0157

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104
Q

Shistocytes seen in which E coli

A

0157 (EHEC) - Causing HUS

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105
Q

Tropics
->chronic diarrhoea + migrating skin rash (+ possibly cough)
Marked eosinophilia
Dx?
Transmission?
Rx?

A

Stronglyotides
Through skin
Ivermectin / albendazole

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106
Q

Need a rapid diagnosis in meningococcal septicaemia with purpuric rash over most of body?

A

Blood PCR

(LP slower and likely contraindicated - lots of rash means DIC / Thrombocytopenia likely)

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107
Q

TB meningitis usually affects which cranial nerves? Often no mycobacteria seen on CSF - how can you increase rapid identification?

A

3 and 5

Nucleic acid amplification

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108
Q

Indinavir - drug used in HIV. What happens to 10% of peeps

A

renal stones

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109
Q

Diagnosis of dengue? Which viral protein?

A

PCR
NS1 - viral protein
ELISA - IgG / IgM

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110
Q

Ades aegypti [or less commonly ades albopictus] carry wot

A

Dengue, yellow fever, Zika, chikungunyna

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111
Q

Who gets dengue vaccine CYD-TDV?

A

People infected once before

[For people who are dengue naive - can mean they get a more severe reaction to dengue when they get infected]

112
Q

Of vivax and ovale which malaria causes more severe disease ? What might be seen on the blood film

A

Vivax
‘signet-ring’ trophozoites

113
Q

Primaquine is used for treatment of malaria. What do you need to screen for before starting treatment

A

G6PD

114
Q

Dysentery in nurseries with highly infectious

A

Shigella

115
Q

Anal clamydia Rx? If pregnant? Do you do a test of cure?

A

Doxy

Azithromyin

Only do a TOC if pregnant - after 3 weeks

116
Q

Which hepatitis are there vaccines for

A

A and B

117
Q

Chronic irregular plaque like lesion with central scarring from africa / india

A

Lupus vulgaris
-Most common form of cutaneous TB

118
Q

numerous Annular rimmed lesions with punched out hypo-pigmented anaesthetic centre

A

Borderline leprosy

119
Q

How is coxiella spread to humans

A

Inhalation of infected dust or unpasteurised milk

[spread between animals via tics]

120
Q

HIV Low CD4 (<50) and eye infection? seen on fundoscopy?

A

CMV

‘creamy coloured’ and pizza pie appearance

121
Q

Dendritic ulcers on eye caused by

A

herpes simplex

122
Q

2 most common causes of meninitis in HIV

A

Toxoplasmosis - 90% of focal CNS lesions (cat poo)
Cryptococcal

123
Q

MR brain in HIV encephalitis
‘multiple ring enhancing lesions’?
‘Widespread small white matter lesions’?

A

Ring enhancing - toxoplasmosis

White matter - PML (Polyomavirus)

124
Q

CSF staining with india ink?

A

Cryptococcal meningitis - visualise yeast cells

125
Q

Highest sens/spec for cryptococcal meningitis

A

serum cryptococcal antigen (CRAG)

126
Q

HIV PML (Progressive multifocal leukoencephalopathy) diagnostic test

A

CSF for JC virus DNA

[Polyomavirus JC (often called JC virus)]

127
Q

Key Ix in HIV opthalmic disease

A

CMV / Toxoplasmosis IgG

128
Q

Tropics
cavitating lesions in lungs, eosinophilia, granulomas on bronch

A

paragonimiasis

[Hydatid would not cause granulomas]

129
Q

Alziehermers like + small unreactive pupil
AND CV disease

Infection?

A

Tertiary syphilus

130
Q

Hypoglycaemia following quinine caused by

A

Quinine stimulates Insulin release

131
Q

Suspected tetanus - Immediate Rx

A

Anti-tetanus immunoglobulin

132
Q

Incubation period of rabies

A

few months

133
Q

Confirm Dx lime disease?

A

ELSIA

134
Q

Diagnosis of primary syphilis? Monitor treatment?

A

Diagnosis - swab ulcer and send for PCR

VRDL serology - positive in active disease and negative following treatment
[NOTE VRDL can be positive in other conditions… preg/SLE/TB/antiphospholipid]

135
Q

Kernig vs brudinski

A

kernig - pain on flexing knee when hips flexed

Brudinski - hips flex on bending head
[Jamie Nods head and says bruh]

136
Q

Post exposure contacts of meningitis get?

A

Cipro - 1 dose
[often given dex too]

137
Q

Bug from soil and plant. Red non render lesion several weeks later moves along lymphatics and leaves string of ulcers? Rx?
Grown on Sabourad dextrose agar

A

Sporothrix schnekii
itraconazole
[or amphrotericin B if immunocompromised ]

138
Q

which proteins used by HIV to get into cells

A

Gp120 fuses to CD4 receptor
GP41 to penetrate cell

139
Q

Most common and important mycobacterium causing chest symptoms bar tb

A

mycobacterium avium complex

140
Q

2 epithelial cancers caused by EBV

A

Nasopharyngeal (100% have EBV genome)

Gastric

141
Q

Cervival cancer linked to which bug

A

HPV

142
Q

Colon cancer linked to which 2 virus

A

CMV
JC virus

[Strep bovis]

143
Q

Atypical lymphocytosis seen in

A

EBV

144
Q

How does monospot test work

A

Uses horse / bovine red cells which cross react with HETEROPHILE ANTIBODIES

145
Q

Symptoms of infectious mononucleosis with lymphocytosis but negative heterophiles antibodies. What Ix?

A

Viral capsid antigen (VCA)

IgM - From start of infection for couple months

IgG after 2 weeks and present for life

[Can do PCR - this is indicated in suspected meningitis too]

146
Q

EBV has high risk splenic rupture due to splenomegaly. What ix often used prior to return to contact sport?

A

US abdo - Ensure spleen back to normal size

147
Q

Maternal rash in firsst trimester

Baby has Zig-zag rash with erythema. microphthalmia and low birth weight?
What is microphthalmia

A

microphthalmia - defects with eyes

Varacella zoster (chicken pox)

148
Q

Who gets varicella zoster Ig?

A

Pregnant, breast feeding, immunocompromised, neonates

149
Q

Recent eaten food ->
Profuse vomiting, mild non bloody diarrhoea, Tachy and hypotensive, Erythematous rash =?

A

Toxic shock syndrome - staph exotoxins (TSST-1)

[e coli 0157 would have bloody diarrhoea]

150
Q

2 bugs causing toxic shock

A

Staph
Strep pyogenes

151
Q

Typhoid caused by? Differentiate from usual salmonella

A

S typhi / s parathyphi

Has fever, rash and constitutional Sx
-Diarrhoea usually only mild with constipation predominately

152
Q

Toxoplasmosis CNS rx?

A

Pyrimethamine and sulphadiazine

153
Q

Cryptococcus CNS Rx?

A

Amphotericin B and flucytosine

154
Q

PCP blood / cxr? Whats clinical sign often mentioned in question?

A

Lymphopenia
Bilat subtle changes

IVDU
Desaturation on minimal exertion

155
Q

When is treatment failure in TB? What do you add in MDR?
MDR length of treatment?

A

Positive cultures after 4 months

Add in a quinolone -floxacin (min 5 drugs in total)

9-12 months

156
Q

Farmer
Fever, malaise, hepatosplenomegally.
Sky high bilirubin, AKI, pyrexia

A

Leptospirosis

157
Q

Some differences in question that would make you think Q fever rather than leptospirosis

A

Q fever would not cause an AKI
- Bili would likely be lower too
-likely pneumonia / culture negative endocaridits

158
Q

Male epididymo-orchitis . Rx ? Rx if STI hinted ?

A

Ofloxacin

Cef IM

159
Q

IVDU differentiate tetanus and botulism

A

Tet - starts with trismus and then spasms

Bot - Usually start with visual, speech or swallowing disturbance.
motor / autonomic. No sensory Sx

160
Q

What does the botulism toxin do?

A

It is a metalloprotienase which cleaves SNARE proteins at neuro muscular junction.
-> inhibits Ach release

161
Q

Usual presentation of sx in botulism

A

Symmetrical decending flacid paralysis
SENSORY IS NORMAL

Autonomic - Retention, constipation, dry mouth

162
Q

Difference in Rx of infant vs adult botulism

A

Infant - botulism Ig

Adult - Botulism antitoxin (horse derived)

163
Q

Need to be careful prescribing what in pharyngitis with lymph nodes

A

Amox / ampicillin

If has Infectious mononucleosis -> rash

164
Q

Chlamydia Rx 1st line

A

Doxy 7 days
Azithromycin 3 days (with loading)

Erythromycin 10-14 days if doxy not tolerated

165
Q

Nec fasc which bug produces gas -> crepitus

A

Clostridium perfringes

166
Q

Types I-IV of nec fasc

A

I - mixed an/aerobes

II - Group A strep

III - Gram neg - usually Aeromonas hyydrophilia / vibro ssp.
[Sea water in wounds / fishing injuries]

IV - Fungal

167
Q

Fungal nec fasc.
Usual bug in immunocompromised? Burns?

A

immunocompromised- Candida

Burns - zygomycetes

168
Q

Listeria CSF

A

High protein
low glucose
lymphocyte predominant

[Similar to TB]

169
Q

Difference between
Lepromatous leprosy (mycobactum leprae)

Tuberculoid leprosy

A

Both cause skin plaques

Lepromatous leprosy has lots of acid fast bacili on biopsy
-involves nose/mouth/kidneys/genitals
-More contagious

Tuberculoid (strong T cell response and no detectable bacilli)
-Numb to touch

[can get borderline - somewhere between two]

170
Q

Transmission of M Leprae? What temp does it grow best?

A

Respiratory droplets

Grows at 27-30 degrees -> likes skin

171
Q

Leprosy usual ABX regime contains

A

Dapsone daily and rifampicin usually for 2 years!

[May get thalidomide to suppress immune system - obvs not if preg]

172
Q

pharyngitis
Grey white exudative ‘membrane’ which bleeds when removed?
[may get neuropathy / pus filled blisters]
Ix?
Rx?

A

Diphtheria

Elek’s test - toxin detection
Immonochromatographic test strip - rapid detection

Penicillin [erythromycin if allergic]
Diphtheria antitoxin

173
Q

P vivax / ovale Rx

A

Chloroquine and primaquine

In these to forms and not in falciparum you get hypnoozytes in liver.
-Need the primaquine to target the disease in liver
->prevent future relapse following Rx

174
Q

chickenpox >18 with anything but a very mild rash =

A

oral acyclovir

(IV if severe)

175
Q

Kaposi sarcoma caused by which virus

A

Human Herpesvirus 8
HHV-8

176
Q

Persistent pyrexia in endocarditis despite IV Abx indicates? Seen on ECG?

A

Abscess - often aortic root

Prolonged PR

[Needs surgical opinion]

177
Q

Hi triglycerides in HIV drugs caused by

A

Protease inhibitors
Ritonavir / lopinavir

Navir tease them with sweets or fatty foods

178
Q

Hepatitis in HIV drugs which ones

A

Non/nucleoside reverse transcriptase inhibitors (NRTI / NNRTI)
Eg Lamivudine/Nevirapine
-ine

179
Q

Travel
Bite ->blackened core with erythema

Systemic fever, arthralgia, myalgia

A

Rickettsia africae
[african tick bite fever typhus]

180
Q

Rocky mountain spotted fever which bug?

A

Rickettsia Rickettsii

181
Q

HIV drugs classes - how to tell which drug in class and side effects

Fusion inhibitors
Protease inhibitors
Integrase inhibitors
NNRTIs
NRTIs

A

Fusion inhibitors - [prevent Fusion of rock and tide on the beach]
- maraviroc and enfurvitide

Protease inhibitors
All end in -navir
-Cause hyperglycaemia/raised triglycerides + nausea / diarrhoea [navir -tease them with sweets or fat foods]

InTERGRAse inhibitors - Prevent HIV cells integrating with host cells
- all have -TERGRA- in middle
-Get fat and raised CK
(not going to INTEGRate with CK model)

NNRTIs
All have -vir- in middle
Vivid dreams, hepatitis

NRTIs
Everything else
Cause myelosuppression (give GCSF / Epo] and renal impairment

182
Q

From India - intermittent bouts of bloody diarrhoea and chronic RUQ pain. Key Ix?

A

Amoeba serology

183
Q

Positive
HBVsAg
HBV IgG
=

A

Chronic hep B

184
Q

What has better anaeorbic cover - co-amox or cipro?

A

Co-amox

185
Q

Travel to SE Asia, headache, myalgia, maculopapular rash, bone pain
Lymphopenia and thrombocytopenia

A

Dengue

186
Q

Travel
key symptom being debilitating arthralgia and fever. Differentiate from dengue

A

Chikungunya
[would not have low WCC or abdo pain as in dengue]

187
Q

Travel, fever really bad muscle pain and headache

A

Typhoid

188
Q

Tenofovir key side effect

A

Renal tubular damage

189
Q

SE asia now 6 month history of vague abdo discomfort, eosinophilia occational diarrhoea and intermittent rash

A

Strongylodiasis

190
Q

Bum sex -> profuse bloody diarrhoea

A

Shigella

191
Q

What are the HACEK organisms ? Gram stain

A

Gram negative rod

Haemophilus species
Aggregatibacter species, Cardiobacterium hominis
Eikenella corrodens
Kingella species

192
Q

Acinetobacter gram stain? Causes?

A

Gram negative rod
HAP / VAP

193
Q

Erythematous rash, hepatosplenomegally, pancytopenia
Amastigoties detected. Dx? Rx?

A

Visceral leishmaniasis

Liposomal Amphorotectin B (or pentamadine)

[Sodium stibogluconate second line]

194
Q

Africa
Now intense itching with urticaria over the body, arthralgia and sensation of something crawling through eye?
Dx?

A

Loa loa (African eye worm)
Blood film - see adult worm

195
Q

Gram -ve rods . When would you think typhoid over E coli bacteraemia

A

Typhoid
-Relative brady
-Constipation or only mild diarrhoea
-Rose spots

E coli
-More unwell
UTI/renal symotoms as well

196
Q

Contact with sheep or goats. Solitary lesion usually on hand which goes on to ulcerate

A

Orf
[one of the pox virus]

197
Q

Possible screeninng blood test for PCP

A

Beta-D glucan
[present on walls of PCP cysts
And fungi]

198
Q

Africa and animals in question
Several months history
Eosinophilia
Lung and liver cysts =? Bug?

A

Hydatid disease
Echinococcus granulosus

199
Q

Which primary cell receptor does HIV bind to on which cell? using?

A

CD4 on T-helper cells using protein gp120

200
Q

Multiple painful penile ulcers with tender lymphadenopathy

A

Herpes simplex

201
Q

History of erythema migrans - usually on foot caused by? Actual name?

A

Hookworm -
Ancylostoma duodenale / braziliense
Necator americanus.

202
Q

What part of life cycle do vivax and ovale have that falciparum doesn’t? What is the drug to treat this?

A

hypnozoites
(Dormant stage in liver)

Primaquine

203
Q

Africa 10 YEARS AGO
now has genitourinary issues ?
bloody diarrhoea?

A

Shistosomiasis haematobium [urinary]

Shistosomiasis mansomi [bowel Sx]
also s. japonikum / mekongi, guineensis

[Need to just recognise that the haematobium is the urinary and any of the other colonise bowel mostly]

204
Q

Chlamydia pneumonia Rx

A

Macrolide - just like any atypical
Eg Clari

Flueoroquinolones if unable Eg levoflox

205
Q

High risk needlestick - known Hep C - What is management

A

Wash out wound
Monthy HepC RNA levels -> treat if rises

206
Q

HSV eye infection Rx

A

Topical aciclovir

207
Q

Hx of lime disease -> sudden collapse

A

AV block

208
Q

Hx of lime disease -> sudden collapse

A

AV block

209
Q

Hx of lime disease -> sudden collapse

A

AV block

210
Q

Visits Africa. Lesion with black centre on foot with systemic rash and symptoms? Rx?

A

Doxy
African tick bite fever

211
Q

Rose spots =? Rx?

A

Typhoid fever
Ceftriaxone for Rx

212
Q

BV most common bug?

A

Gardnrella vaginalis

[smelly vag garden]

213
Q

Elective splenectomy - when pneumococcal vaccine

A

2-6 weeks pre op

214
Q

Eye damaged by vegetation. Now has an ulcer with creamy infiltrate?

A

Aspergillus in the eye

215
Q

HLA B27
HLA DQ2
HLA DR2
HLA DR3
HLA DR4

A

HLA B27 - sero neg arthirits
HLA DQ2 - coeliac
HLA DR2 - MS
HLA DR3 - Diabetes (and other autoimmune)
HLA DR4 - Rheum arthritis / diabetes

216
Q

South America - several erythematous nodules on arms, now developing a golden crust =?

A

Cutaneous leishmaniasis

217
Q

Lime disease sx - if there is an eschar what is it?

A

rickettsia
Eg Spotted fever

[Still ticks, still doxy]

218
Q

Hep B sAg+ve, cIgG +ve, IgMAb -ve =

A

Chronic carrier

219
Q

Weird severe diarrhoea on return from south America - not responding well to Cipro / metron - what now?

A

Septrin
[Caused by a cyclospora cayetanesis]

220
Q

Who has duffy red cell antigen? Good for?

A

West Africans - protects against P Vivax

221
Q

Africa. Urticarial rash raised eosinophils but normal WCC, diarrhoea and Abdo pain.
Explain why diagnosis is and not one of the differentials

A

Strongyloides

Not Shitsto mansoni - would have bloody diarrhoea and severe abdo Sx

Not Entamboea - 80% have normal eosinophils and raised WCC. Bloody diarrhoea too

222
Q

HIV - White patches on tongue that cant be dislodged

A

EBV - Hairy leukoplakia

223
Q

Needlestick from someone with HIV - risk of getting infected

A

1/300

224
Q

Most common cause of treatment failure in HIV

A

Poor compliance

225
Q

Knee replacement. Now develops very slow onset symptoms of Septic arthritis over weeks. What bug?

A

Staph epidermis
[Less virulent = slower Sx]

226
Q

Sex in Africa. Multiple tender ulcers on end of penis + lymphadenopathy? Bug? Rx?

A

Chancroid - especially if africa
Haemophilus ducreyi
[Usually starts with 1 ulcer which breaks down then lots]

Single dose Cef / Azithro
[7 days erythro]

[Herpes would more likely be not on end of the penis]

227
Q

Watery diarrhoea in HIV

A

Cryptosporidium
[Nitazoxanide for Rx]

228
Q

Farmer. Lymphadenoathy, reduced WCC, hepatomegally ? Rx

A

Brucellosis
Needs multidrug Rx for around 6 weeks
Eg - Doxy + rifampicin + bit of amionoglycoside

229
Q

Oesophagitis in HIV

A

Fluconazole - its candida

230
Q

Bat bite UK rx

A

Rabies vaccination + Ig

231
Q

Echlar and then systemic rash after travel to Australia bug

A

Orientia tsutsugamushi
[Scrub typus]

232
Q

Cough conjunctivitis widespread rash

A

Measels

233
Q

Painless single growing penis ulcer, following return from papa new guinne? Bug?

A

Granuloma inguinale [donovanosis]
Klebsiella granulomatis

Chancroid would be painful

Lymphogranuloma venereum (chlamydia) would present similarly

234
Q

Flu-like symptoms
yellow gray ulcers in mouth
Vesicular rash on hands and feet bug?

A

Coxacie - Hand foot and mpouth

235
Q

Toxic shock - need to add in which abx

A

Clinda

236
Q

HepB -> decompensated liver failure Rx?

A

Entecavir or tenofovir

237
Q

South america - some symptoms
then measels like rash
Macules -> purpura
Encephalitis sx =?
Bug?
rx?

A

Epidemic typhus
Rickesittsia prowazekii

[sends you pro-wazekii]

Doxy / azithro

238
Q

How long untreated HIV -> HIV related infections

A

5-10 years

239
Q

Previous cut. painless Swelling over site -> ulcer with puss and yellow crust . Gram +ve branching fillamentous bacteria =?

A

Nocardia
[needs septrin]

240
Q

HepC rx

A

Daclastasvir + sofosbuvir

241
Q

Most common side effect ribavirin? Used for?

A

HepC treatment
Haemolytic anaemia (average 2g/dL)

242
Q

Pen allergic. Which Abx for bacterial meningitis? What if >50

A

Chloramphenicol
Add in septirn for listeria cover

243
Q

How many agents for how long in HIV needlestick PEP

A

3 agents for 1 month

244
Q

Chlamydia gram stain

A

Too small to be seen!
As an intracellular parasite it cant grow on cell-free media

245
Q

Difference between an endotoxin and exotocin. Which in staph / diphtheria?

A

Exotoxin - produced by bacteria Eg Staph/Diptheria/botulism]
[think toxin produced and pushed out Exo]

Endo - Part of cell wall of gram -ve bacteria and released on cell death -> inflam response
[End of their life]

246
Q

Mouth trauma Eg tooth extraction/ cut on gum. Slow developing hard abscess with pus. Sulphur granules present on microscopy. What are the two differentials and how to differentiate?

A

Actinomycosis - most common
-Grows on Anaerobic culture

Nocardiosis
-Does NOT grow anaerobically

247
Q

LRTI with patchy consolidation, Diarrhoea, SIADH, confusion. Multiple people affected?

A

Legionella

248
Q

Vivax Rx if return from SE Asia ?

A

Artemether-lumefantrine and primaquine

[Swap chloroquine for Artemether-lumefantrine as chloroquine resistance high in SE asia ]

249
Q

EBV first line Ix for Dx

A

heterophil antibody test (monospot)

250
Q

Breakdown causes of diarrhoea in HIV poor controlled? If watery? bloody?

A

40% protozoal - Crypto/microsporidiosis - watewry

20% each
-Bacterial
-Mycobactum (avium common)
-viruses - probably CMV

Bloody - salmonella / CMV

251
Q

Rx cryptosporidium? Microsporidia ?

A

None for crypto - bar hydration and immune system reconstruction

Mirco - albendazole

252
Q

MAI in HIV usually seen when?Rx

A

CD4 <50
Presents with disseminated infection
12months TB Rx

253
Q

Salmonella / shigella Rx hiv

A

Azithromycin

254
Q

Tropical sprue and amoeba differentiate by symptoms

A

Amoebea the diarrhoea is often bloody

255
Q

B-lymphocytes in HIV? Gamma globulins?

A

B cells normal / [raised plasma cells]

Hypergammaglobulinaemia

256
Q

Epidemic typhus which vector

A

Louse

[pediculus humans humans]

257
Q

Prevention of vertical transmission of HIV best thing

A

Post natal zidovudine

258
Q

CMV retinitis / disseminated CMV makes you think CD4 count is?

A

<100

259
Q

Diabetes, otitis externa and facial nerve palsy =

A

Pseudomonas

[simple otitis externa is staph Aureus]

260
Q

TB from Russian prison. What they got

A

MDR TB
Needs specialist input

261
Q

Young Brazilian presents with cardiac failure and indigestion. Cardiomyopathy on echo…? Bug?

A

Chagas

Trypanosoma cruizi

262
Q

Pregnancy - contact with a kid who has chickenpox Rx?

A

VZV IgG testing first

if negative -> VZV Ig

263
Q

Generalised lymphadenopathy and mild hepatitis 6 weeks after unprotected sex. HIV test negative

A

CMV

264
Q

Headaches, rash, flu-like symptoms, mild decreased WCC / platelets. Travel

A

Dengue

265
Q

Untreated syphilis risk of developing tertiary syphilis

A

30%

266
Q

Male vs female Ix gonnorrhea

A

Male - Urine for NAAT
fEMALE eNDOCERVICAL SWAB FOR naat

267
Q

Proglottids in stool mean s infection with? Rx?

A

Tapeworm [Taenia …
Niclosamide / praziquantel

268
Q

watery diarrhoea in new HIV + low cd4 with oocytes seen on zheil Neilson stain? Rx?

A

Cryptosporidium
Antiretroviral therapy

269
Q

Suspected lime disease Eg erythema migrans and hx of possible tic bite ix?

A

No Ix just treat with doxy / amox for 2-3 weeks

270
Q

HepB/C dual acute infection. Which is causing the hepatitis ?

A

HepB

271
Q

Antimalrials for someone with epilepsy

A

Malarone

272
Q

Type of vacccine is chicken pox

A

Live attenuated

273
Q

Athletes foot. 3 main causes
Multiple small microconidia?
Single microcondidia / macroconidia?
No conidia?

A

Multiple small microconidia - Trichophyton

Single microcondidia / macroconidia - Microsporum

No conidia - epidermophyton

274
Q

Shisto with urinary Sx Key Ix?

A

Urine analysis and culture

275
Q

Neiserria vs pneumococcal meningitis contacts prophylaxis

A

Neisseria - cipro
Pneumo - do nothing

276
Q

HIV PEP eg

A

tenofovir + emtricabine plus ratelgravir

MRCP PART 1 (22 decks)

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