Infectious disease Flashcards
What causes lime disease? How does it present? Ix? Rx? Most common chonic issue
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…
Leigonella presentation? If this presentation in a child? Diagnostic test ? Abx of choice?
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
CSF in viral encephalitis
Normal protein / glucose
Lymphocyte predominant
Clear in colour
What causes mumps
paramyxovirus
Scattered clusters of vesicular rash -> shortness of breath and cough…Diagnosis? Rx? Other common complications
Varicella zoster - chicken pox
Aciclovir (+immunoglobulin if needed)
Encephalitis / hepatitis / pneumonia
3 bugs you are at risk of with hyposplepnism
Pneumococcal
N meningitides
H influenzae type B
[vaccines and lifelong peniciln)
TB meningitis length of treatment
12 months
+ 2 months steroids
[pulm TB is 6 months]
CNS CMV infection treatment if immunocompromised
Ganciclovir
Encephalitis MRI Pick up of:
Herpes simplex
Varicella zoster
CMV
Harold takes very odd climbing decisions
HSV - Temporal
VSV - Occipital
CMV - Deep white matter
Visceral Leishmaniasis. Ix to make a diagnosis? Vector? Rx?
Biopsy Eg. Bone marrow aspirate/spleen / lymph nodes
Sandfly
Liposomal amphotericin B
Cutaenous leishimaniais presentation? Dx? Management?
Ulcer
Skin biopsy
Sodium stilbogluconate
Asymptomatic UTI in pregnancy treatment
Treat - Eg nitro/amox
Name 3 times you would treat asymptomatic bacteriuria
Pregnancy
before an invasive urological procedure
Immunocompromised
Bacterial vaginosis. Which commensal microbe is usually replaced?
Lactobacilli (replaced by anerobes)
[think lacto = breast milk]
Malaria which mosquito? Which is the severe one? Diagnosis?
female anopheles
Plasmodium falciparum
[all plasmodiums]
Serial Thick and thin blood film
Malaria is key differential in anyone whos just been to Africa + abdo tenderness / neurological Sx and fever. What if they also have a rash
malaria-like + rash = DENGUE
If ELISA tests (IgM/IgG) negative for lime disease how do you test?
Repeat ELISA after 4 weeks
Immunoblot if >12 weeks
What is a Jarisch Herxheimer reaction
Reaction following Abx Rx of lime disease.
[Thought to be from bacterial cell death -> fever / myalgia / headache
Should spontaneously recover ]
Diagnosis of gonorrhoea? Rx? Follow up?
NAAT testing
IM cef
Follow up in 1 week to check sx resolution + test of cure
What is Fitz-hugh-curtis syndrome
peri-Hepatic abscess in gonorrhoea
[Fitz Hugh and curtis all have gonorrhea ]
3 most common bugs for immunocompromised bacterial meningitis
N meningitidies, Strep Pneumo, Listeria monocytogenes
[+ gram neg bacilli)
listeria abx? Where do you catch listeria? Who gets serious listeria bar immunocompromised?
Febrile gastroenteritis - amox / co-trimox
Systemic / CNS - Ampicillin
[Most non immunocompromised do not require Rx]
Food poisoning
Neonates -> CNS infection as in immunocompromised
Most common cause of pneumonia
Strep pneumo
Erythema multiform in which common bacteria
Mycoplasma pneumonia
Blood markers of severe pneumonia
Positive blood cultures
PO2 <8 despite O2
Multilobar
WCC <4.3 OR >20.3
Hypoalbuminaemia
Rx of P. Falicparum
Artemether and lumefantrine
If severe - IV artesunate
Where do malarial sporozites replicate? What causes jaundice in malaria?
In the liver
After replicating -> bloodstream and infect RBCs causing intermittent haemolysis, fevers and jaundice
[RBC lysis releases more malria into blood -> enter cycle]
What is algid malaria ?
Malaria + gram negative sepsis [bad]
What is the thick and thin blood film for in malaria
Thick - identidy if infection
Thin - identify species
Severe malaria features
4 things found on ABG?
Hb <50
Hypoglycaemia <2.2
Ph <7.3
Lactate >5
Conciousness
Shock
Haemoglobinuria (blackwater fever)
Oliguria
Which malaria if severe anaemia, SPLENIC RUPTURE, and AKI?
P Vivax
Usual Rx of typhoid (salmonella)
Ceftriaxone / cefiximine
[or Fluoroquinolone]
How does salmonella get into blood?
Through Peyers patch in distal ileum -> reticuloendothelial system (liver, spleen, marrow)
Salmonella incubation period
12-72 hrs
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?
Usually constipation
Rose spots (erythematous maculopapular on chest/abdo)
‘pea soup’ diarrhoea
Splenomegally + neuro Sx
Salmonella usually diagosed with blood / stool cultures
How to differentiate s.typhi or s.parathypi
Widal’s agglutination test
Work on a farm -> incubation
headaches, fevers, dry cough, endocarditis, derranged LFTS and hepatosplenomegaly ? Diagnosis? Rx?
Q fever - Coxiella burnetti
Doxy
Q fever in preganacy Rx
5 weeks co-trimoxazole
tic bite -> not lime disease? and develops maculapaular rash where? Rx?
What if in migrant camp?
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
HIV when do you prescribe PCP prophylaxis?
When CD4 < 200 [co-trimoxazole]
Or if have had previous treatment for PCP
Which malarias may return after initial infection?
vivax and ovale
Atovaquone and proguanil is?
Malarone
Cultivation of (for diagnosis of):
Nocardia ssp
Chlamydia
Mycobacterium leprae
Nocardia ssp - parafin
Chlamydia - cell cutlture
Mycobacterium leprae - mouse foot pad innoculation
ssP - Parafin
C-C
M - M
Worldwide most common cause of iron deficinecy anaemia?
Hookworm
Usual means of infection of hookworm? Basic pathogenesis? present? Key finding on routine Ix? Dx? ?Rx?
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
Topical podophyllotoxin /imiquinod used in
Extensive genital warts / anal warts [need to check HIV for extensive disease- as likely immunocompromised]
There are over 100 types of HPV
Which in anal warts and the most common vag warts?
Which causes cervical Ca? Oropharyngeal Ca
Anal - 6 and 11
Ca - 16 and 18 [16 in oral Ca]
Who gets a yearly smear test?
HIV
Usual treatment of cutaneous HPV
Weekly paring (basically filing them down)
+ salycilic acid
PEP for HIV… Just need to recognise it
Tenofovir/Emtricitabine (Truvada ®) + Ritonavir
Tenofovir/Emtricitabine (Truvada ®) + Lopinavir
HIV 1 vs HIV 2 distribution
1 - Worldwide
2 - only in west africa really
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?
HIV RNA + p24 antigen
HIV RNA (viral load) and CD4 count for markers of disease
HAART involves how many drugs? classes?
Minimum 3
Nucleosise reverse transcriptase inhibitors
Protease inhibots
Integrase inhibitors
Cat scratch fever
Scratch -> lymphadenopathy
Caused by?
Bartonella henselae
Bartonella henselae vs bartonella quintana
Henselae - cat scratch fever
Quintana - from human louse infection -> trench fever eg in displaced populations
How does denge present
repeated biphasic ‘sadlleback’
Fever, chills, retro orbital headache and a widespread maculopapular rash
When do you get rose spots ? what are they?
Typhoid fever - salmonella
Pink blanching macules on trunk
Constipation and a parodoxical relative brady?
Salmonella
Returning traveller with macuolpapular rash what things are we considering ?
Urticarial rash?
Dengue
HIV seroconversion
Zika
Chikungunya
Urticarial - shisto
Black eschlars (necrotic tissue on top of ulcer) on skin seen in
Scrub typhus
Cutaneous anthrax (often IVDU)
Rickettsal infection Rx? If pregnant?
Doxy
Chloramphenicol if preh
How to differentiate HBV immunity from past infection and from immunisation
Past infection will have Core antibodies and surface antibodies
Immunise only uses surface antigen -> only surface antibodies
Whats the small lung leison in TB called? How do the bacteria get about
Ghon focus
Through lymphatics
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?
Auramine
Cultured on lo-wenstein-jensen medium for at least 6 weeks.
TB PCR
HIV + pleural effusion usually
TB
PCP more just pneumo for exam
When is a mantoux test for TB positive? How to detect response of white cells to TB antigens?
if it is >5mm after 2-3 days
interferon gamma release assay
Length of drugs in TB
RI = 6 months
PE - 2 months
When is a smear positive patient with TB considered non-infective
Following 2 weeks of tb chemo (RIPE)
Which TB drug causes optic neuritis / reduced acuity)
Ethambutol
[Eye]
Which TB drug gives peripheral neuropathy? Drug to prevent this given to Eg alcoholics/diabetes/renal failure
Isonazid
Can give pyridoxine
Red/dark yellow urine with TB drugs?
Rifampacin
What is potts disease
Crush fracture of thoracic spine due to TB osteomyelitis
Approx intervals between exposure to … and diarrhoea sx?
S aureus
C botulinum
Salmonella
V colera
S aureus 1-6 hours
C botulinum 12-36hrs [plus weakness]
Salmonella 12-48hrs
V colera 1-5 days
Most common cause of IE?
S AUREUS
Whooping cough bug? Usual Rx?
Bordetella pertussis
Erythromycin
Toxoplasmosis CNS infection on CT
Ring enhancing lesions
Where is the host of toxoplasmosis . How many people in UK infected? Usual method of transmission?
intestines of cats
Incidence of about 25% [90% asymptomatic]
Eating undercooked meat [not cat meat lol]
Toxoplasmosis usally asymotomatic and no treatment. If treatment is required, its usually a combination including? Drug to prevent vertical transmission?
Pyrimethamine
Spiramycin
STI in traveller with painful rugged ulcer + lymph node swelling
Gram negative rod?
Bug name?
Rx?
chancroid
haemophylis ducreyi
Single does Oral azithromycin / cef IM
How does primary syphilis present
painless clean ulcer
Staph vs strep down a microscope
Both gram positive coccus
Staph - clusters
strep - chains/ pairs
STI gram negative diplococci is
Gonorrhoea
Not chlamydia
What are koplik’s spots? Pathognomonic of
White papules with erythematous base in oral mucosa
Measles
Mealses presentation ? Bug?
Flu like + conjunctivitis
-> rash usually starting behind ears
[koplik spots in mouth]
RNA Morbillivirus
‘slapped check’ syndrome caused by?
Parovirus b19
Syphilis caused by ?
primary vs secondary? Where is rash
Treponema pallidum
Primary - painless ulcer
Secondary - maculopapular rash on palms / soles, genital ulcers (Condylomata lata), snail tract lesions in oral mucosa, lymphadenopathy
Fit and well asymptomatic bacteruria - would you repeat it?
NO
Wuchereria bancrofti causes
lymphatic filiarasis
Blood transfusion in UK
3 Weeks later - pharyngitis / lymphadenopathy and mild derranged LFTs
CMV
(Hep viruses screened - CMV is not unless blood for immunocompromised )
Fever, severe pharyngitis, neck swelling + significant lymphadenopathy. Raw meat in history
Oropharyngeal anthranx considered
Usually has an inflammatory lesion which goes on to ulcerate / necrosis
Anthrax usual place infected? How does this present
95% cutaneous
Purple infected papule -> vesicle -> ulcerates -> black eschar
[consider this especially if from an injection site in IVDU]
SEX then 2-4 weeks later
Fever, myalgia, tender cervical lymphadenopathy, Erythematous maculopapular rash
HIV seroconversion
Severe cellulitis and pen allergic. First line? When would you use vanc?
Clinda usually - also switches off bacterial toxin production
Vanc if MRSA
Differentiate erysipelas and cellulitis
erysipelas - raised and well differentiated border
[superficial whereas cellulitis involves sub cut tissue]
Cellulitis usually S aureus / Strep pyogenes. Triggers from question…
Hot tubs, sponges, nail puncture
Pseudomonas
Cellulitis usually S aureus / Strep pyogenes. Triggers from question…
saltwater
freshwater
Salt water - vibrio vulnificus
[Vulfunucus sound you make tryna swim in waves]
Fresh - Aeromonas hydrophilia
[Fresh aer water]
Cellulitis usually S aureus / Strep pyogenes. Triggers from question…
Butchers, vets, fishmongers
Erysipelothirx rhusiopathiae
Cellulitis usually S aureus / Strep pyogenes. Triggers from question…
Aquarium handlers
mycobacterium marinium
Cellulitis usually S aureus / Strep pyogenes. Triggers from question…
Cat/dog bite
Pasteurella multocida
capnocytophaga canimorsus
[senior pascal, the Ca[p]t
Cellulitis usually S aureus / Strep pyogenes. Triggers from question…
human bite
eikenella corrodens
[Eik a human bit me]
Cellulitis usually S aureus / Strep pyogenes. Triggers from question…
rodent
streptobacillus moniliformis
What is a furuncle ? carbuncle
Painful lump filled with pus
Same but bigger
Which E coli most common for infant diarrhoea ?
Community / travellers diarrhoea?
Dysentery ?
EPEC -P Peads
ETEC - T travel
EIEC - I invasive
EHEC (0157)- Oh HEC its 0157
Shistocytes seen in which E coli
0157 (EHEC) - Causing HUS
Tropics
->chronic diarrhoea + migrating skin rash (+ possibly cough)
Marked eosinophilia
Dx?
Transmission?
Rx?
Stronglyotides
Through skin
Ivermectin / albendazole
Need a rapid diagnosis in meningococcal septicaemia with purpuric rash over most of body?
Blood PCR
(LP slower and likely contraindicated - lots of rash means DIC / Thrombocytopenia likely)
TB meningitis usually affects which cranial nerves? Often no mycobacteria seen on CSF - how can you increase rapid identification?
3 and 5
Nucleic acid amplification
Indinavir - drug used in HIV. What happens to 10% of peeps
renal stones
Diagnosis of dengue? Which viral protein?
PCR
NS1 - viral protein
ELISA - IgG / IgM
Ades aegypti [or less commonly ades albopictus] carry wot
Dengue, yellow fever, Zika, chikungunyna
Who gets dengue vaccine CYD-TDV?
People infected once before
[For people who are dengue naive - can mean they get a more severe reaction to dengue when they get infected]
Of vivax and ovale which malaria causes more severe disease ? What might be seen on the blood film
Vivax
‘signet-ring’ trophozoites
Primaquine is used for treatment of malaria. What do you need to screen for before starting treatment
G6PD
Dysentery in nurseries with highly infectious
Shigella
Anal clamydia Rx? If pregnant? Do you do a test of cure?
Doxy
Azithromyin
Only do a TOC if pregnant - after 3 weeks
Which hepatitis are there vaccines for
A and B
Chronic irregular plaque like lesion with central scarring from africa / india
Lupus vulgaris
-Most common form of cutaneous TB
numerous Annular rimmed lesions with punched out hypo-pigmented anaesthetic centre
Borderline leprosy
How is coxiella spread to humans
Inhalation of infected dust or unpasteurised milk
[spread between animals via tics]
HIV Low CD4 (<50) and eye infection? seen on fundoscopy?
CMV
‘creamy coloured’ and pizza pie appearance
Dendritic ulcers on eye caused by
herpes simplex
2 most common causes of meninitis in HIV
Toxoplasmosis - 90% of focal CNS lesions (cat poo)
Cryptococcal
MR brain in HIV encephalitis
‘multiple ring enhancing lesions’?
‘Widespread small white matter lesions’?
Ring enhancing - toxoplasmosis
White matter - PML (Polyomavirus)
CSF staining with india ink?
Cryptococcal meningitis - visualise yeast cells
Highest sens/spec for cryptococcal meningitis
serum cryptococcal antigen (CRAG)
HIV PML (Progressive multifocal leukoencephalopathy) diagnostic test
CSF for JC virus DNA
[Polyomavirus JC (often called JC virus)]
Key Ix in HIV opthalmic disease
CMV / Toxoplasmosis IgG
Tropics
cavitating lesions in lungs, eosinophilia, granulomas on bronch
paragonimiasis
[Hydatid would not cause granulomas]
Alziehermers like + small unreactive pupil
AND CV disease
Infection?
Tertiary syphilus
Hypoglycaemia following quinine caused by
Quinine stimulates Insulin release
Suspected tetanus - Immediate Rx
Anti-tetanus immunoglobulin
Incubation period of rabies
few months
Confirm Dx lime disease?
ELSIA
Diagnosis of primary syphilis? Monitor treatment?
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]
Kernig vs brudinski
kernig - pain on flexing knee when hips flexed
Brudinski - hips flex on bending head
[Jamie Nods head and says bruh]
Post exposure contacts of meningitis get?
Cipro - 1 dose
[often given dex too]
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
Sporothrix schnekii
itraconazole
[or amphrotericin B if immunocompromised ]
which proteins used by HIV to get into cells
Gp120 fuses to CD4 receptor
GP41 to penetrate cell
Most common and important mycobacterium causing chest symptoms bar tb
mycobacterium avium complex
2 epithelial cancers caused by EBV
Nasopharyngeal (100% have EBV genome)
Gastric
Cervival cancer linked to which bug
HPV
Colon cancer linked to which 2 virus
CMV
JC virus
[Strep bovis]
Atypical lymphocytosis seen in
EBV
How does monospot test work
Uses horse / bovine red cells which cross react with HETEROPHILE ANTIBODIES
Symptoms of infectious mononucleosis with lymphocytosis but negative heterophiles antibodies. What Ix?
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]
EBV has high risk splenic rupture due to splenomegaly. What ix often used prior to return to contact sport?
US abdo - Ensure spleen back to normal size
Maternal rash in firsst trimester
Baby has Zig-zag rash with erythema. microphthalmia and low birth weight?
What is microphthalmia
microphthalmia - defects with eyes
Varacella zoster (chicken pox)
Who gets varicella zoster Ig?
Pregnant, breast feeding, immunocompromised, neonates
Recent eaten food ->
Profuse vomiting, mild non bloody diarrhoea, Tachy and hypotensive, Erythematous rash =?
Toxic shock syndrome - staph exotoxins (TSST-1)
[e coli 0157 would have bloody diarrhoea]
2 bugs causing toxic shock
Staph
Strep pyogenes
Typhoid caused by? Differentiate from usual salmonella
S typhi / s parathyphi
Has fever, rash and constitutional Sx
-Diarrhoea usually only mild with constipation predominately
Toxoplasmosis CNS rx?
Pyrimethamine and sulphadiazine
Cryptococcus CNS Rx?
Amphotericin B and flucytosine
PCP blood / cxr? Whats clinical sign often mentioned in question?
Lymphopenia
Bilat subtle changes
IVDU
Desaturation on minimal exertion
When is treatment failure in TB? What do you add in MDR?
MDR length of treatment?
Positive cultures after 4 months
Add in a quinolone -floxacin (min 5 drugs in total)
9-12 months
Farmer
Fever, malaise, hepatosplenomegally.
Sky high bilirubin, AKI, pyrexia
Leptospirosis
Some differences in question that would make you think Q fever rather than leptospirosis
Q fever would not cause an AKI
- Bili would likely be lower too
-likely pneumonia / culture negative endocaridits
Male epididymo-orchitis . Rx ? Rx if STI hinted ?
Ofloxacin
Cef IM
IVDU differentiate tetanus and botulism
Tet - starts with trismus and then spasms
Bot - Usually start with visual, speech or swallowing disturbance.
motor / autonomic. No sensory Sx
What does the botulism toxin do?
It is a metalloprotienase which cleaves SNARE proteins at neuro muscular junction.
-> inhibits Ach release
Usual presentation of sx in botulism
Symmetrical decending flacid paralysis
SENSORY IS NORMAL
Autonomic - Retention, constipation, dry mouth
Difference in Rx of infant vs adult botulism
Infant - botulism Ig
Adult - Botulism antitoxin (horse derived)
Need to be careful prescribing what in pharyngitis with lymph nodes
Amox / ampicillin
If has Infectious mononucleosis -> rash
Chlamydia Rx 1st line
Doxy 7 days
Azithromycin 3 days (with loading)
Erythromycin 10-14 days if doxy not tolerated
Nec fasc which bug produces gas -> crepitus
Clostridium perfringes
Types I-IV of nec fasc
I - mixed an/aerobes
II - Group A strep
III - Gram neg - usually Aeromonas hyydrophilia / vibro ssp.
[Sea water in wounds / fishing injuries]
IV - Fungal
Fungal nec fasc.
Usual bug in immunocompromised? Burns?
immunocompromised- Candida
Burns - zygomycetes
Listeria CSF
High protein
low glucose
lymphocyte predominant
[Similar to TB]
Difference between
Lepromatous leprosy (mycobactum leprae)
Tuberculoid leprosy
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]
Transmission of M Leprae? What temp does it grow best?
Respiratory droplets
Grows at 27-30 degrees -> likes skin
Leprosy usual ABX regime contains
Dapsone daily and rifampicin usually for 2 years!
[May get thalidomide to suppress immune system - obvs not if preg]
pharyngitis
Grey white exudative ‘membrane’ which bleeds when removed?
[may get neuropathy / pus filled blisters]
Ix?
Rx?
Diphtheria
Elek’s test - toxin detection
Immonochromatographic test strip - rapid detection
Penicillin [erythromycin if allergic]
Diphtheria antitoxin
P vivax / ovale Rx
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
chickenpox >18 with anything but a very mild rash =
oral acyclovir
(IV if severe)
Kaposi sarcoma caused by which virus
Human Herpesvirus 8
HHV-8
Persistent pyrexia in endocarditis despite IV Abx indicates? Seen on ECG?
Abscess - often aortic root
Prolonged PR
[Needs surgical opinion]
Hi triglycerides in HIV drugs caused by
Protease inhibitors
Ritonavir / lopinavir
Navir tease them with sweets or fatty foods
Hepatitis in HIV drugs which ones
Non/nucleoside reverse transcriptase inhibitors (NRTI / NNRTI)
Eg Lamivudine/Nevirapine
-ine
Travel
Bite ->blackened core with erythema
Systemic fever, arthralgia, myalgia
Rickettsia africae
[african tick bite fever typhus]
Rocky mountain spotted fever which bug?
Rickettsia Rickettsii
HIV drugs classes - how to tell which drug in class and side effects
Fusion inhibitors
Protease inhibitors
Integrase inhibitors
NNRTIs
NRTIs
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
From India - intermittent bouts of bloody diarrhoea and chronic RUQ pain. Key Ix?
Amoeba serology
Positive
HBVsAg
HBV IgG
=
Chronic hep B
What has better anaeorbic cover - co-amox or cipro?
Co-amox
Travel to SE Asia, headache, myalgia, maculopapular rash, bone pain
Lymphopenia and thrombocytopenia
Dengue
Travel
key symptom being debilitating arthralgia and fever. Differentiate from dengue
Chikungunya
[would not have low WCC or abdo pain as in dengue]
Travel, fever really bad muscle pain and headache
Typhoid
Tenofovir key side effect
Renal tubular damage
SE asia now 6 month history of vague abdo discomfort, eosinophilia occational diarrhoea and intermittent rash
Strongylodiasis
Bum sex -> profuse bloody diarrhoea
Shigella
What are the HACEK organisms ? Gram stain
Gram negative rod
Haemophilus species
Aggregatibacter species, Cardiobacterium hominis
Eikenella corrodens
Kingella species
Acinetobacter gram stain? Causes?
Gram negative rod
HAP / VAP
Erythematous rash, hepatosplenomegally, pancytopenia
Amastigoties detected. Dx? Rx?
Visceral leishmaniasis
Liposomal Amphorotectin B (or pentamadine)
[Sodium stibogluconate second line]
Africa
Now intense itching with urticaria over the body, arthralgia and sensation of something crawling through eye?
Dx?
Loa loa (African eye worm)
Blood film - see adult worm
Gram -ve rods . When would you think typhoid over E coli bacteraemia
Typhoid
-Relative brady
-Constipation or only mild diarrhoea
-Rose spots
E coli
-More unwell
UTI/renal symotoms as well
Contact with sheep or goats. Solitary lesion usually on hand which goes on to ulcerate
Orf
[one of the pox virus]
Possible screeninng blood test for PCP
Beta-D glucan
[present on walls of PCP cysts
And fungi]
Africa and animals in question
Several months history
Eosinophilia
Lung and liver cysts =? Bug?
Hydatid disease
Echinococcus granulosus
Which primary cell receptor does HIV bind to on which cell? using?
CD4 on T-helper cells using protein gp120
Multiple painful penile ulcers with tender lymphadenopathy
Herpes simplex
History of erythema migrans - usually on foot caused by? Actual name?
Hookworm -
Ancylostoma duodenale / braziliense
Necator americanus.
What part of life cycle do vivax and ovale have that falciparum doesn’t? What is the drug to treat this?
hypnozoites
(Dormant stage in liver)
Primaquine
Africa 10 YEARS AGO
now has genitourinary issues ?
bloody diarrhoea?
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]
Chlamydia pneumonia Rx
Macrolide - just like any atypical
Eg Clari
Flueoroquinolones if unable Eg levoflox
High risk needlestick - known Hep C - What is management
Wash out wound
Monthy HepC RNA levels -> treat if rises
HSV eye infection Rx
Topical aciclovir
Hx of lime disease -> sudden collapse
AV block
Hx of lime disease -> sudden collapse
AV block
Hx of lime disease -> sudden collapse
AV block
Visits Africa. Lesion with black centre on foot with systemic rash and symptoms? Rx?
Doxy
African tick bite fever
Rose spots =? Rx?
Typhoid fever
Ceftriaxone for Rx
BV most common bug?
Gardnrella vaginalis
[smelly vag garden]
Elective splenectomy - when pneumococcal vaccine
2-6 weeks pre op
Eye damaged by vegetation. Now has an ulcer with creamy infiltrate?
Aspergillus in the eye
HLA B27
HLA DQ2
HLA DR2
HLA DR3
HLA DR4
HLA B27 - sero neg arthirits
HLA DQ2 - coeliac
HLA DR2 - MS
HLA DR3 - Diabetes (and other autoimmune)
HLA DR4 - Rheum arthritis / diabetes
South America - several erythematous nodules on arms, now developing a golden crust =?
Cutaneous leishmaniasis
Lime disease sx - if there is an eschar what is it?
rickettsia
Eg Spotted fever
[Still ticks, still doxy]
Hep B sAg+ve, cIgG +ve, IgMAb -ve =
Chronic carrier
Weird severe diarrhoea on return from south America - not responding well to Cipro / metron - what now?
Septrin
[Caused by a cyclospora cayetanesis]
Who has duffy red cell antigen? Good for?
West Africans - protects against P Vivax
Africa. Urticarial rash raised eosinophils but normal WCC, diarrhoea and Abdo pain.
Explain why diagnosis is and not one of the differentials
Strongyloides
Not Shitsto mansoni - would have bloody diarrhoea and severe abdo Sx
Not Entamboea - 80% have normal eosinophils and raised WCC. Bloody diarrhoea too
HIV - White patches on tongue that cant be dislodged
EBV - Hairy leukoplakia
Needlestick from someone with HIV - risk of getting infected
1/300
Most common cause of treatment failure in HIV
Poor compliance
Knee replacement. Now develops very slow onset symptoms of Septic arthritis over weeks. What bug?
Staph epidermis
[Less virulent = slower Sx]
Sex in Africa. Multiple tender ulcers on end of penis + lymphadenopathy? Bug? Rx?
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]
Watery diarrhoea in HIV
Cryptosporidium
[Nitazoxanide for Rx]
Farmer. Lymphadenoathy, reduced WCC, hepatomegally ? Rx
Brucellosis
Needs multidrug Rx for around 6 weeks
Eg - Doxy + rifampicin + bit of amionoglycoside
Oesophagitis in HIV
Fluconazole - its candida
Bat bite UK rx
Rabies vaccination + Ig
Echlar and then systemic rash after travel to Australia bug
Orientia tsutsugamushi
[Scrub typus]
Cough conjunctivitis widespread rash
Measels
Painless single growing penis ulcer, following return from papa new guinne? Bug?
Granuloma inguinale [donovanosis]
Klebsiella granulomatis
Chancroid would be painful
Lymphogranuloma venereum (chlamydia) would present similarly
Flu-like symptoms
yellow gray ulcers in mouth
Vesicular rash on hands and feet bug?
Coxacie - Hand foot and mpouth
Toxic shock - need to add in which abx
Clinda
HepB -> decompensated liver failure Rx?
Entecavir or tenofovir
South america - some symptoms
then measels like rash
Macules -> purpura
Encephalitis sx =?
Bug?
rx?
Epidemic typhus
Rickesittsia prowazekii
[sends you pro-wazekii]
Doxy / azithro
How long untreated HIV -> HIV related infections
5-10 years
Previous cut. painless Swelling over site -> ulcer with puss and yellow crust . Gram +ve branching fillamentous bacteria =?
Nocardia
[needs septrin]
HepC rx
Daclastasvir + sofosbuvir
Most common side effect ribavirin? Used for?
HepC treatment
Haemolytic anaemia (average 2g/dL)
Pen allergic. Which Abx for bacterial meningitis? What if >50
Chloramphenicol
Add in septirn for listeria cover
How many agents for how long in HIV needlestick PEP
3 agents for 1 month
Chlamydia gram stain
Too small to be seen!
As an intracellular parasite it cant grow on cell-free media
Difference between an endotoxin and exotocin. Which in staph / diphtheria?
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]
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?
Actinomycosis - most common
-Grows on Anaerobic culture
Nocardiosis
-Does NOT grow anaerobically
LRTI with patchy consolidation, Diarrhoea, SIADH, confusion. Multiple people affected?
Legionella
Vivax Rx if return from SE Asia ?
Artemether-lumefantrine and primaquine
[Swap chloroquine for Artemether-lumefantrine as chloroquine resistance high in SE asia ]
EBV first line Ix for Dx
heterophil antibody test (monospot)
Breakdown causes of diarrhoea in HIV poor controlled? If watery? bloody?
40% protozoal - Crypto/microsporidiosis - watewry
20% each
-Bacterial
-Mycobactum (avium common)
-viruses - probably CMV
Bloody - salmonella / CMV
Rx cryptosporidium? Microsporidia ?
None for crypto - bar hydration and immune system reconstruction
Mirco - albendazole
MAI in HIV usually seen when?Rx
CD4 <50
Presents with disseminated infection
12months TB Rx
Salmonella / shigella Rx hiv
Azithromycin
Tropical sprue and amoeba differentiate by symptoms
Amoebea the diarrhoea is often bloody
B-lymphocytes in HIV? Gamma globulins?
B cells normal / [raised plasma cells]
Hypergammaglobulinaemia
Epidemic typhus which vector
Louse
[pediculus humans humans]
Prevention of vertical transmission of HIV best thing
Post natal zidovudine
CMV retinitis / disseminated CMV makes you think CD4 count is?
<100
Diabetes, otitis externa and facial nerve palsy =
Pseudomonas
[simple otitis externa is staph Aureus]
TB from Russian prison. What they got
MDR TB
Needs specialist input
Young Brazilian presents with cardiac failure and indigestion. Cardiomyopathy on echo…? Bug?
Chagas
Trypanosoma cruizi
Pregnancy - contact with a kid who has chickenpox Rx?
VZV IgG testing first
if negative -> VZV Ig
Generalised lymphadenopathy and mild hepatitis 6 weeks after unprotected sex. HIV test negative
CMV
Headaches, rash, flu-like symptoms, mild decreased WCC / platelets. Travel
Dengue
Untreated syphilis risk of developing tertiary syphilis
30%
Male vs female Ix gonnorrhea
Male - Urine for NAAT
fEMALE eNDOCERVICAL SWAB FOR naat
Proglottids in stool mean s infection with? Rx?
Tapeworm [Taenia …
Niclosamide / praziquantel
watery diarrhoea in new HIV + low cd4 with oocytes seen on zheil Neilson stain? Rx?
Cryptosporidium
Antiretroviral therapy
Suspected lime disease Eg erythema migrans and hx of possible tic bite ix?
No Ix just treat with doxy / amox for 2-3 weeks
HepB/C dual acute infection. Which is causing the hepatitis ?
HepB
Antimalrials for someone with epilepsy
Malarone
Type of vacccine is chicken pox
Live attenuated
Athletes foot. 3 main causes
Multiple small microconidia?
Single microcondidia / macroconidia?
No conidia?
Multiple small microconidia - Trichophyton
Single microcondidia / macroconidia - Microsporum
No conidia - epidermophyton
Shisto with urinary Sx Key Ix?
Urine analysis and culture
Neiserria vs pneumococcal meningitis contacts prophylaxis
Neisseria - cipro
Pneumo - do nothing
HIV PEP eg
tenofovir + emtricabine plus ratelgravir
