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MRCP Part 1 > infectious disease > Flashcards

infectious disease Flashcards

1
Q

walking barefoot –> abdominal pain, pruritus, diarrhoea, and an itchy lesion on the plantar aspect of the foot which resolved spontaneously

A

Strongyloides stercolaris

treatment of choice is ivermectin or albendazole

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2
Q

cholera mx

A

doxycycline

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3
Q

prolonged non-bloody diarrhoea

A

giardiasis

metronidazole

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4
Q

Infection:
haematuria and increased urinary frequency

A

schistosomiasis, a parasitic flatworm

mx. Praziquantel

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5
Q

signs of Dengue fever

A

Retro-orbital headache, fever, facial flushing, rash, thrombocytopenia in returning traveller

can progress to viral haemorrhagic fever

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6
Q

1st line abx for uti in pregnancy

A

nitrofurantoin

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7
Q

swam in Lake Malawi –> itch

A

Schistosomiasis is treated with praziquantel

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8
Q

chest x-ray containing a rounded opacity. A crescent sign may be present

A

aspergilloma

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9
Q

what accounts for around 50% of cerebral lesions in patients with HIV?

A

cerebral toxoplasmosis

constitutional symptoms, headache, confusion, drowsiness
CT: usually single or multiple ring-enhancing lesions, mass effect may be seen
management: pyrimethamine plus sulphadiazine for at least 6 weeks

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10
Q

measles

A

conjunctivitis
kolpick white spots in mouth
maculopapu;ar rash starting behind ears

mx. supportive, mmr vaccine

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11
Q

Patients with severe malaria should be treated with ?

A

IV artesunate, and in cases where parasitaemia >10% is seen, consideration should be given to the performance of exchange transfusions.

In severe falciparum malaria, the parasite can cause sequestration of RBCs; hence the role of exchange transfusions

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12
Q

management of cutaneous anthrax

A

ciprofloxacin

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13
Q

Patients with an uncertain tetanus vaccination history should be given?

A

a booster vaccine + immunoglobulin, unless the wound is very minor and < 6 hours old

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14
Q

antibiotic to treat MRSA infections

A

vancomycin

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15
Q

prophylaxis for contacts of patients with meningococcal meningitis

A

Oral ciprofloxacin or rifampicin

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16
Q

most common isolated organism in animal bites

A

Pasteurella multocida

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17
Q

which vitamin is given with TB treatment because one of the TB drugs causes peripheral neuropathy?

A

isoniazid causes peripheral neuropathy
give vit B6 (pyridoxine) to prevent

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18
Q

check visual acuity before and during treatment with which TB drug?

A

ethambutol

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19
Q

which TB drug results in arthralgia and gout?

A

Pyrazinamide

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20
Q

most common cause of viral meningitis

A

non-polio enteroviruses e.g. coxsackie virus, echovirus

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21
Q

causes of viral haemorrhagic fever

A

dengue fever, Lassa fever, Ebola, yellow fever

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22
Q

how does yellow fever present?

A

high fever, rigors, nausea & vomiting. Bradycardia may develop. A brief remission is followed by jaundice, haematemesis, oliguria

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23
Q

causes of genital warts

A

Genital warts - 90% are caused by HPV 6 & 11

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24
Q

management of genital herpes in pregnancy

A

primary infection - elective c section to avoid transmission

recurrent herpes - suppressive aciclovir from 36weeks, low transmission risk

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25
Q

measles symptomms

A

Measles is characterised by prodromal symptoms, Koplik spots. maculopapular rash starting behind the ears and conjunctivitis

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26
Q

how does tetanus cause its effects?

A

Tetanus toxin (tetanospasmin) blocks the release of the inhibitory neurotransmitters GABA and glycine resulting in continuous motor neuron activity

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27
Q

non falciparum malaria types and presentation

A

malaria - fever, headache, splenomegaly

vivax/ovale - cyclical fever every 48 hrs

malariae - cyclical fever every 72 hrs + nephrotic syndrome

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28
Q

non falciparum management

A
  1. artemisinin-based combination treatment of chloroquine
  2. vivax + ovale can relapse following treatment so primaquine is given following acute treatment
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29
Q

A 17-year-old girl presents to the emergency department complaining of a widespread erythematous rash. She has recently been commenced on amoxicillin for an upper respiratory tract infection by her general practitioner. Which of the following is the most appropriate test to provide a diagnosis?

A

This is infectious mononucleosis

heterophil antibody test (Monospot test) Is diagnostic

Commonly develop rash after penicillin when gave infectious mononucleosis

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30
Q

Most common cause of neutropenia sepsis in cancer patients

A

Coagulase-negative, Gram-positive bacteria such as Staphylococcus epidermidis

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31
Q

What is used as prophylaxis for contacts of patients with meningococcal meningitis

A

Oral ciprofloxacin (one dose) or rifampicin (1 tab BD for two days)

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32
Q

I
What is red man syndrome?

A

nfusion-related reaction peculiar to vancomycin [3]. It typically consists of pruritus, an erythematous rash that involves the face, neck, and upper torso. Less frequently, hypotension and angioedema can occur.

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33
Q

What is the Jarisch-Herxheimer reaction?

A

acute febrile reaction that occurs within the first 24 hours of initiating treatment for spirochetal infections, such as syphilis caused by Treponema pallidum and Lyme disease. It is characterized by fever, chills, headache, myalgia, and exacerbation of skin lesions. The reaction is believed to be due to the release of endotoxin-like substances from the dying spirochetes. The symptoms usually resolve within a few hours to a day.

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34
Q

whipple’s disease pneumonic

A

Weight loss
Hyperpigmentation
Infection by Tropheryma whippelii
PAS positive granules in macrophages
Polyarthritis
Lymphadenopathy
E
Steattorhoea diarrhoea

dementia, seizures

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35
Q

what is macrophage activation syndrome?

A

uncontrolled hyper-inflammatory state associated with many systemic autoimmune diseases but in particular Juvenile Idiopathic Arthritis.

ACR/EULAR classification criteria for macrophage activation syndrome (MAS) state that in a patient with JIA who presents with a fever, a diagnosis of MAS can be made if the 1. ferritin level is > 684 ng/ml
2. any two of the following are present (platelets < 181 * 109/L, AST > 48 U/L, triglycerides > 156 mg/dl, fibrinogen < 360 mg/dl).

Refractory fever and hepatosplenomegaly

Interferon-gamma is responsible for the activation of macrophages and is heavily implicated in the pathogenesis of this condition.

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36
Q

patient presents with black eschar scab that is typically painless. what disease?

A

anthrax

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37
Q

treatment for anthrax

A

ciproflox

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38
Q

treatment for non gonococcal uretheritis

A

doxycycline or azithromycin

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39
Q

Congenital toxoplasmosis
signs

A

cerebral cmalcification
chorioretinitis

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40
Q

mx gonorrhoea

A

Intramuscular ceftriaxone +/- cipro

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41
Q

mx chlamydia

A

Oral doxycycline

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42
Q

how does Clostridium tetani exert its effects?

A

blocks the release of GABA and glycine –> muscle spasms, hypertonia –> lockjaw and respiratory paralysis

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43
Q

‘erythematous, punctate, and papilliform’ cervix with itching and foul smelling discharge

A

‘erythematous, punctate, and papilliform’ - also known as ‘strawberry’ - cervix

Trichomonas vaginalis

oral metronidazole

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44
Q

is the first-line antibiotic treatment for tetanus

A

metronidazole to destroy the bacteria
(in addition to the immunoglobulin to neutralise the toxin)

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45
Q

Perianal itching in children, possibly affecting other family members →

A

Enterobius vermicularis (threadworms)

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46
Q

Gram-positive cocci

A

= staphylococci + streptococci (including enterococci)

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47
Q

Gram-negative cocci

A

= Neisseria meningitidis + Neisseria gonorrhoeae, also Moraxella catarrhalis

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48
Q

Gram-positive rods (bacilli)

A

mnemonic = ABCD LT
Actinomyces
Bacillus anthracis (anthrax)
Clostridium
Diphtheria: Corynebacterium diphtheriae
Listeria monocytogenes
Tropheryma whipplei (Whipple’s disease)

49
Q

Gram-negative rods

A

Escherichia coli
Haemophilus influenzae
Pseudomonas aeruginosa
Salmonella sp.
Shigella sp.
Campylobacter jejuni

50
Q

HIV in pregnancy

A

during pregnancy - continue antivirals

<50 copies, can do vaginal delivery with zidovudine infusion started 4hrs before + neonatal oral zidovudine antiviral therapy

if maternal viral load is >50 copies/ml - neonate needs triple ART for 4-6 weeks.

no breastfeeding

51
Q

Chikungunya vs dengue

A

severe joint pain with Chikungunya

mx. supportive

52
Q

common antibiotic that increases risk of acquisition of MRSA

A

Ciprofloxacin (quinolones)

53
Q

first-line investigation for suspected Lyme disease in patients with no history of erythema migrans

A

ELISA antibodies to Borrelia burgdorferi then immunoblot

54
Q

how does strongyloides present?

A

in soil, penetrates skin

diarrhoea

papulovesicular rash over areas where the larvae crossed

larva currens: pruritic, linear, urticarial rash that moves as the larvae move through the body

pneumonitis

55
Q

mx strongyloides

A
  1. ivermectin
  2. albendazole
56
Q

PCP mx

A

1) co-trimoxazole
2) IV pentamidine in severe cases
3) aerosolized pentamidine is an alternative treatment for Pneumocystis jiroveci pneumonia but is less effective with a risk of pneumothorax
4)steroids if hypoxic

57
Q

flu like illness → brief remission→ followed by jaundice and haematemesis

A

Yellow fever

58
Q

syphillis presentation

A

primary
- painless ulcer at site of sexual contact (chancre)
- local lymphadenopathy

secondary (6-10weeks later)
- fevers
- rash
- warty lesions around genitals (condylomata lata)

Tertiary/ late
- gummas (granulomatous lesions of the skin and bones)
- ascending aortic aneurysms
- general paralysis of the insane
- tabes dorsalis
- Argyll-Robertson pupil: bilateral small pupils that fail to constrict in response to bright light but exhibit constriction during near vision tasks

59
Q

management of syphillis

A

benzylpenicillin

2nd line - doxy

60
Q

stain for cryptosporidium

A

stool: modified Ziehl-Neelsen stain (acid-fast stain) of the stool –> red cysts of cryptosporidium

61
Q

Mx. Chicken pox exposure in pregnancy

A

Do antibody levels if unsureof vaccination history - wait for result if unsure vaccinated

Give varicella zoster immunoglobulin immediately or oral aciclovir 7-14days after exposure

62
Q

how is lassa fever spread?

A

Lassa fever is contracted by contact with the excreta of infected African rats (Mastomys rodent) or by person-to-person spread

63
Q

what is the leading cause of death in patients with Chagas’ disease?

A

Cardiac involvement - myocarditis

64
Q

Leprosy mx.

A

This man has multibacillary leprosy (>6 lesions) so should have triple therapy with rifampicin, dapsone and clofazimine for 12 months.

For paucibacillary leprosy (5 or less lesions) you should give rifampicin and dapsone for 6 months.

65
Q

When to treat asymptomatic bacteriuria?

A

pregnancy, children younger than 5 years or immunosuppressed patients due to the risk of complications.

66
Q

most likely infective cause of hepatitis in pregnancy?

A

Severe hepatitis in a pregnant woman - think hepatitis E

67
Q

Diptheria clinical manifestations

A

fever, malaise, and the presence of a grey coating on the tonsils (known as a pseudomembrane)

extensive cervical lymphadenopathy (sometimes referred to as ‘bull neck’)

68
Q

the most common complication of gonorrhoea?

A

Infertility secondary to pelvic inflammatory disease (PID)

69
Q

who is at risk of leptospirosis and what are the symptoms?

A

spread by contact with infected rat urine

the early phase is due to bacteraemia and lasts around a week:
- may be mild or subclinical
fever
- flu-like symptoms
- subconjunctival suffusion (redness)/haemorrhage

second immune phase may lead to more severe disease (Weil’s disease)
- acute kidney injury (seen in 50% of patients)
- hepatitis: jaundice, hepatomegaly
- aseptic meningitis

70
Q

False positive VDRL/RPR:

A

‘SomeTimes Mistakes Happen’ (SLE, TB, malaria, HIV)

71
Q

Parasitaemia cut off for severe m. Falciparum

A

> 2%

72
Q

rhabditiform larvae

A

strongyloides

73
Q

What changes need to be made to anti-tuberculosis regime given renal impairment?

A

Reduction in ethambutol dose

74
Q

The most common causes of viral meningitis in adults are

A

enteroviruses.

75
Q
A
75
Q

antibiotic for liver abcess

A

amoxicillin + ciprofloxacin + metronidazole

76
Q

management of HIV in newborns from HIV positive mothers

A

Neonatal antiretroviral therapy
zidovudine is usually administered orally to the neonate if maternal viral load is <50 copies/ml.

Otherwise triple ART should be used. Therapy should be continued for 4-6 weeks.

77
Q

common side effect of tetracyclines

A

discolouration of teeth: therefore should not be used in children < 12 years of age
photosensitivity
angioedema
black hairy tongue

78
Q

Management of diptheria

A

intramuscular penicillin
diphtheria antitoxin

79
Q

Management of brain abscess

A

Management
surgery
a craniotomy is performed and the abscess cavity debrided
the abscess may reform because the head is closed following abscess drainage.
IV antibiotics: IV 3rd-generation cephalosporin + metronidazole
intracranial pressure management: e.g. dexamethasone

80
Q

HIV: anti-retrovirals - P450 interaction

A

nevirapine (a NNRTI): induces P450

protease inhibitors: inhibits P450

81
Q

Staphylococcal toxic shock syndrome is characterised by

A

fever, hypotension and a rash → desquamation

82
Q

pneumonia commonly due to aspiration

A

Klebsiella

83
Q

Severe falciparum malaria management

A

a parasite counts of more than 2% will usually need parenteral treatment irrespective of clinical state

  1. intravenous artesunate
  2. if parasite count > 10% then exchange transfusion should be considered
84
Q

Genital wart treatment

A

multiple, non-keratinised warts: topical podophyllum
solitary, keratinised warts: cryotherapy

85
Q

which type of glomerulonephritis is most characteristically associated with streptococcal infection in children?

A

Diffuse proliferative glomerulonephritis

86
Q

painful vs painless genital ulcers

A

Syphilis, Lymphogranuloma venereum (LGV) and donovanosis (granuloma inguinal) all cause painless genital ulcers.

Behcets may cause painful genital ulcers but herpes simplex is more likely if recent change in sexual partner and the lack of other symptoms.
Chancroid - painful ulcer. sharply defined, ragged, undermined border + inguinal lymphadenopathy.

87
Q

where are the majority of gastrinomas are found

A

in the first part of the duodenum

88
Q

B12 deficient mx

A

1 mg of IM hydroxocobalamin 3 times each week for 2 weeks, then once every 3 months
66%

89
Q

which TB drug causes peripheral neuropathy?

A

Isoniazid therapy can cause a vitamin B6 deficiency causing peripheral neuropathy

90
Q

Severe joint pain and high fever after return from Africa.
Normal blood results

A

chikungunya

91
Q

most common cause of reactive arthritis in the UK

A

Chlamydia trachomatis

92
Q

Treatment of pelvic inflammatory disease:

A

oral ofloxacin + oral metronidazole or intramuscular ceftriaxone + oral doxycycline + oral metronidazole

93
Q

HIV, neuro symptoms, widespread demyelination

A

progressive multifocal leukoencephalopathy

94
Q

granuloma inguinale organism

A

: Klebsiella granulomatis*

95
Q

HIV testing

A

1) HIV-1/2 Ab/Ag Immunoassay (fourth generation) – within 10 days of infection

2) HIV-1 NAAT or p24 testing

96
Q

causes of Gingival hyperplasia:

A

phenytoin, ciclosporin, calcium channel blockers and AML

97
Q

Management of suspected/confirmed Lyme disease

A

doxycycline if early disease

Amoxicillin is an alternative if doxycycline is contraindicated (e.g. pregnancy)

98
Q

Lyme disease is caused by

A

the spirochaete Borrelia burgdorferi

99
Q

the most common cause of osteomyelitis

A

Staphylococcus aureus

100
Q

first-line management
for syphillis

A

intramuscular benzathine penicillin is the first-line management
alternatives: doxycycline

101
Q

Cat scratch disease organism

A
  • caused by Bartonella henselae
102
Q

Sepsis triggers the release of which cytokine

A

IL-1 causing vasodilation → hypotension

103
Q

Varicella pneumonia is the most common and serious complication of chickenpox infection in adults. treatment

A

Auscultation of the chest is often unremarkable.

IV aciclovir

104
Q

Leishmeniasis
- clinical manifestations and diagnosis

A

spread by sand flies

three manifestations:

cutaneous - ulcer

mucousal - ulcer of mucosa

visceral aka. kala azar
- fever, sweats, rigors
- massive splenomegaly
- hepatomegaly
- bone marrow: pancytopenia
- grey skin - ‘kala-azar’ means black sickness

the gold standard for diagnosis is bone marrow or splenic aspirate

105
Q

chlamydia mx

A
  1. doxy 7 days
  2. if pregnant: azithromycin, erythromycin or amoxicillin
106
Q

if allergic to penicillin, the person might also be allergic to?

A

cephalosporins.

107
Q

Immune reconstitution inflammatory syndrome can occur in HIV positive patients when starting anti-retrovirals; this is an immune phenomenon that results in the clinical worsening of a pre-exisiting opportunistic infection

A
108
Q

which HIV type is more pathogenic

A

HIV 1 is more dangerous than 2

109
Q

HPV 8 vs HHV 8

A

HPV 8 - cervical, head and neck ca

HHV 8 - kaposi

110
Q

Blackwater fever - what is it?

A

is a rare complication of malaria which can be fatal. It is caused by large intravascular haemolysis resulting in haemoglobinuria, anaemia, jaundice and acute kidney injury. Urine is classically black or dark red in colour.

111
Q

schistosomiasis, urine microscopy would show ?

A

red cell casts

112
Q

Infection characterised by parkinsonian features

A

inflammation of basal ganglia
japanese encephalitis
supportive mx

113
Q

how is lassa fever spread?

A

rats

114
Q

Examples of viral haemorrhagic fever (VHF) include:

A

Flaviviridae: dengue, yellow fever
Arenaviridae: Lassa fever
Filoviridae: Ebola virus, Marburg virus
Bunyaviridae: Hantaviruses, Crimean-Congo haemorrhagic fever, Rift Valley fever

115
Q

mx cryptosporidium

A

Management
is largely supportive for immunocompetent patients

if the patient has HIV and is not on antiretroviral therapy then this should be started and often will be enough to resolve the infection

nitazoxanide may be used for immunocompromised patients
rifaximin is also sometimes used for immunocompromised patients/patients with severe disease

116
Q

mx toxoplasmosis

A

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

HIV/ immunosuprressed: management: pyrimethamine plus sulphadiazine for at least 6 weeks

117
Q

Definitive diagnosis of Pneumocystis carinii pneumonia

A

is by bronchial alveolar lavage with silver staining

MRCP Part 1 (21 decks)

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