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infectious disease Flashcards

1
Q

what is rheumatic fever

A

AI condition triggered by strep A bacteria
Usually strep pyogenes (tonsilitis)

Multi-system affecting joints, heart, skin + nervous system
Type 2 hypersensitivity reaction (2-3 wks after inital infection)

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2
Q

rheumatic fever presentation

A

2 – 4 weeks following a streptococcal infection, such as tonsillitis.
Fever
Joint pain - diff ones at diff times
Rash - Erythema marginatum (pink rings)
Shortness of breath
Chorea
Subcutaneous nodules

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3
Q

jones criteria for rheumatic fever+ what you need for dx

A

Dx when there is evidence of recent streptococcal infection, plus:
Two major criteria OR
One major criteria plus two minor criteria

Major Criteria:

J – Joint arthritis
O – Organ inflammation, such as carditis
N – Nodules
E – Erythema marginatum rash
S – Sydenham chorea

Minor Criteria:

F - Fever
E - ECG Changes (prolonged PR interval) without carditis
A - Arthralgia without arthritis
R - Raised inflammatory markers (CRP and ESR)

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4
Q

rheumatic fever ix

A

Throat swab for bacterial culture
ASO antibody titres (show prev group A strep infection)
Echocardiogram, ECG and chest xray can assess the heart involvement
A diagnosis of rheumatic fever is made using the Jones criteria

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5
Q

rheumatic fever tx

A

Tonsillitis caused by streptococcus should be treated with phenoxymethylpenicillin (penicillin V) for 10 days.

Patients with clinical features of rheumatic fever should be referred immediately for specialist management.

NSAIDs for joint pain
Aspirin and steroids for treat carditis
Prophylactic antibiotics (oral or intramuscular penicillin) are used to prevent further streptococcal infections and recurrence of the rheumatic fever. These are continued into adulthood.
Monitoring and management of complications

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6
Q

what type of pneumonia do you get in immunocompromised px

A

Pneumocystis pneumonia (PCP) caused by the pneumocystis jiroveci fungus
get in HIV no meds or after transplant

fever
non-productive cough
breathlessness on exertion

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7
Q

diagnostic ix for PCP

A

bronchoscopy w bronchoalveolar lavage

(in practise often sputum samples for PCR, less invasive)

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8
Q

test to check for h pylori eradication

A

urea breath test

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9
Q

what gut prob can c diff cause

A

pseudomembranous colitis

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10
Q

what abx cause c diff

A

cephalosporins
e.g. cefuroxime and cefoxitin; ceftriaxone and ceftazidime

other RF = PPIs

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11
Q

c diff histology

A

g +ve , spore-forming, exotoxin producing bacillus

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12
Q

mx of c diff first infection

A

oral vancomycin 10 days

second-line therapy: oral fidaxomicin
third-line therapy: oral vancomycin +/- IV metronidazole

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13
Q

recurrent ep c diff mx

A

within 12 wks of prev = oral fidaxomicin
> 12 wks = oral vancomycin OR fidaxomicin

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14
Q

life threatening c diff mx

A

oral vancomycin AND IV metronidazole

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15
Q

what is the most common organism causing septic arthritis in young adults who are sexually active

A

Neisseria gonorrhoeae

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16
Q

what is the overall most common organism causing septic arthritis

A

s aureus

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17
Q

histology of Neisseria gonorrhoeae

A

Gram negative diplococci

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18
Q

histology of s aureus

A

Gram positive staphylococci

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19
Q

mx of wounds re tetanus

if have had full course of 5 vaccines

if not had any

if unsure

A

Patient has had a full course of tetanus vaccines, with the last dose < 10 years ago
- no vaccine nor tetanus immunoglobulin is required, regardless of the wound severity

Patient has had a full course of tetanus vaccines, with the last dose > 10 years ago
- if tetanus prone wound: reinforcing dose of vaccine
- high-risk wounds (e.g. compound fractures, delayed surgical intervention, significant degree of devitalised tissue): reinforcing dose of vaccine + tetanus immunoglobulin

If vaccination history is incomplete or unknown
- reinforcing dose of vaccine, regardless of the wound severity
- for tetanus prone and high-risk wounds: reinforcing dose of vaccine + tetanus immunoglobulin

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20
Q

what to do if in community + suspect bacterial meningitis

A

transfer to hx urgently

IM benzylpenicillin

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21
Q

what warning signs in suspected bacterial meningitis would prompt a senior review

A

rapidly progressive rash
poor peripheral perfusion
respiratory rate < 8 or > 30 / min or pulse rate < 40 or > 140 / min
pH < 7.3 or WBC< 4 *109/L or lactate > 4 mmol/L
GCS < 12 or a drop of 2 points
poor response to fluid resuscitation

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22
Q

when to delay lumbar puncture in suspected bacterial meningitis

A

signs of severe sepsis or a rapidly evolving rash

severe respiratory/cardiac compromise

significant bleeding risk

signs of raised intracranial pressure
- focal neurological signs
- papilloedema
- continuous or uncontrolled seizures
- GCS ≤ 12

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23
Q

mx of px w suspected bacterial meningitis where LP isn’t CI

A

IV access → take bloods and blood cultures

lumbar puncture
- if cannot be done within the first hour, IV antibiotics should be given after blood cultures have been taken

IV antibiotics
< 3 months = cefotaxime + amoxicillin (or ampicillin)
3 months-50 years = cefotaxime (or ceftriaxone)
> 50 years = cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin)

consider IV dexamethasone
- avoid in septic shock, meningococcal septicaemia, or if immunocompromised, or in meningitis following surgery’

CT scan is not normally indicated

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24
Q

mx of meningitis px w signs of raised ICP

A

get critical care input
secure airway + high-flow oxygen
IV access → take bloods and blood cultures
IV dexamethasone
IV antibiotics as above
arrange neuroimaging

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25
Q

meningitis prophylaxis for close contacts (within 7 days b4 onset)

A

oral ciprofloxacin single dose

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26
Q

CSF in LP of bacterial meningitis

A

cloudy
high level of protein
low level of glucose
high WCC - mainly neutrophils

think that the bacteria swimming in the CSF will release proteins and use up the glucose.

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27
Q

CSF in LP of viral meningitis

A

clear
slightly raised/normal level of protein
normal level of glucose
high WCC - mainly lymphocytes

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28
Q

what is lyme disease caused by

A

the spirochaete Borrelia burgdorferi and is spread by ticks

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29
Q

early features of lyme disease

A

Early features (within 30 days)
erythema migrans
- ‘bulls-eye’ rash is typically at the site of the tick bite
- typically develops 1-4 weeks after the initial bite but may present sooner
- usually painless, more than 5 cm in diameter and slowly increases in size
- present in around 80% of patients.

systemic features
- headache
- lethargy
- fever
- arthralgia

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30
Q

mx of cellulitis (class 1)

A

oral flucloxacillin as first-line treatment for mild/moderate cellulitis

oral clarithromycin, erythromycin (in pregnancy) or doxycycline is recommended in patients allergic to penicillin

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31
Q

Management of suspected/confirmed Lyme disease

A

doxycycline if early disease. Amoxicillin is an alternative if doxycycline is contraindicated (e.g. pregnancy)
- people with erythema migrans should be commenced on antibiotic without the need for further tests

ceftriaxone if disseminated disease

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32
Q

what to do before tuberculosis vaccine

A

tuberculin skin test
The only exceptions are children < 6 years old who have had no contact with tuberculosis

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33
Q

what is infectious mononucleosis (glandular fever) caused by

A

EBV

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34
Q

infectious mononucleosis (glandular fever) presentation

A

sore throat
lymphadenopathy
pyrexia

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35
Q

test for infectious mononucleosis (glandular fever)

A

monospot test

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36
Q

tx infectious mononucleosis (glandular fever)

A

supportive
avoid contact sports for 4 weeks

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37
Q

what to do if you have been exposed to hep B

A

if had HBV vaccine - see if you are a vaccine responder/non-responder
non-responder = anti-HBs < 10mIU/ml 1-2 months post-immunisation)

if responder
- give booster dose
if non-responder
- hepatitis B immune globulin (HBIG) and a booster vaccine

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38
Q

what is TB caused by

A

Mycobacterium tuberculosis, a small rod-shaped bacteria (a bacillus)

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39
Q

how to stain mycobacterium tuberculosis

A

Zeihl-Neelsen stain for acid-fast bacilli that will stain red

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40
Q

TB disease course

A

Immediate clearance of the bacteria (in most cases)
Primary active tuberculosis (active infection after exposure)
Latent tuberculosis (presence of the bacteria without being symptomatic or contagious)
Secondary tuberculosis (reactivation of latent tuberculosis to active infection)

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41
Q

what is military TB

A

When the immune system cannot control the infection + disseminated and severe disease develops

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42
Q

what is a cold abscess

A

A firm, painless abscess caused by tuberculosis, usually in the neck. They do not have the inflammation, redness and pain you expect from an acutely infected abscess.

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43
Q

RFs TB

A

Close contact with active tuberculosis (e.g., a household member)
Immigrants from areas with high tuberculosis prevalence
People with relatives or close contacts from countries with a high rate of TB
Immunocompromised (e.g., HIV or immunosuppressant medications)
Malnutrition, homelessness, drug users, smokers and alcoholics

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44
Q

what type of vaccine is BCG

A

live attenuated

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45
Q

what to do before BCG vaccine

A

tested with the Mantoux test and only given the vaccine if this test is negative

assessed for the possibility of immunosuppression and HIV due to the risks related to a live vaccine.

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46
Q

TB presentation

A

chronic, gradually worsening symptoms. Most cases involve pulmonary disease

Cough
Haemoptysis
Lethargy
Fever or night sweats
Weight loss
Lymphadenopathy
Erythema nodosum
Spinal pain in spinal tuberculosis (Pott’s disease of the spine)

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47
Q

tests for an immune response to TB caused by previous infection, latent TB or active TB

A

Mantoux test
Interferon‑gamma release assay (IGRA)

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48
Q

ix to do when active TB is suspected

A

Chest x-ray
= upper lobe cavitation is the classical finding of reactivated TB
= bilateral hilar lymphadenopathy

Sputum cultures GS - allows for the identification of antibiotic sensitivities and resistance, guiding treatment

(can do sputum smear but not as sensitive)
- 3 specimens are needed
- stained for the presence of acid-fast bacilli (Ziehl-Neelsen stain)

NAAT

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49
Q

Disseminated miliary TB CXR

A

millet seeds uniformly distributed across the lung fields

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50
Q

tx active TB

A

R – Rifampicin for 6 months
I – Isoniazid for 6 months
P – Pyrazinamide for 2 months
E – Ethambutol for 2 months

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51
Q

SE of isoniazid + how to help

A

peripheral neuropathy
“I’m-so-numb-azid”

pyridoxine (vitamin B6) is co-prescribed to help prevent this - remember as you take it for 6 months

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52
Q

SE rifampicin

A

red/orange discolouration of secretions, such as urine and tears
“red-I’m-pissin”

potent cytochrome P450 inducer -> reduces the effects of drugs metabolised by this system, such as COCP

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53
Q

SE pyrazinamide

A

hyperuricaemia (high uric acid levels) -> gout and kidney stones.

hepatotoxicity
arthralgia
sideroblastic anaemia

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54
Q

SE ethambutol

A

colour blindness and reduced visual acuity
“eye-thambutol”

optic neuritis

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55
Q

which TB drugs are hepatotoxic

A

Rifampicin, isoniazid and pyrazinamide

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56
Q

presentation genital herpes

A

painful genital ulceration
- may be associated with dysuria and pruritus
the primary infection is often more severe than recurrent episodes
- systemic features such as headache, fever and malaise are more common in primary episodes
tender inguinal lymphadenopathy
urinary retention may occur

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57
Q

ix genital herpes

A

nucleic acid amplification tests (NAAT)

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58
Q

mx genital herpes

A

oral aciclovir

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59
Q

rabies features

A

prodrome: headache, fever, agitation
hydrophobia: water-provoking muscle spasms
hypersalivation
Negri bodies: cytoplasmic inclusion bodies found in infected neurons

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60
Q

following animal bite in countries where there is a risk of rabies

A

the wound should be washed

if an individual is already immunised then 2 further doses of vaccine should be given

if not previously immunised then human rabies immunoglobulin (HRIG) should be given along with a full course of vaccination. If possible, the dose should be administered locally around the wound

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61
Q

what is dengue fever

A

viral disease of the tropics, transmitted by mosquitoes, and causing sudden fever and acute pains in the joints.

can progress to viral haemorrhagic fever

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62
Q

dengue fever classification

A

dengue fever:
- without warning signs
- with warning signs

severe dengue (dengue haemorrhagic fever)

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63
Q

dengue fever presentation

A

FEVER
HEADACHE (often retro-orbital)
myalgia, bone pain and arthralgia (‘break-bone fever’)
pleuritic pain
facial flushing (dengue)
maculopapular RASH
haemorrhagic manifestations
e.g. positive tourniquet test, petechiae, purpura/ecchymosis, epistaxis

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64
Q

dengue fever warning signs

A

abdominal pain
hepatomegaly
persistent vomiting
clinical fluid accumulation (ascites, pleural effusion)

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65
Q

Severe dengue (dengue haemorrhagic fever)

A

a form of disseminated intravascular coagulation (DIC) resulting in:
- thrombocytopenia
- spontaneous bleeding

around 20-30% of these patients go on to develop dengue shock syndrome (DSS)

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66
Q

ix dengue fever

A

typical blood results:
- leukopenia
- thrombocytopenia
- raised aminotransferases

diagnostic tests:
- serology
- NAAT for viral RNA
- NS1 antigen test

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67
Q

tx dengue fever

A

entirely symptomatic e.g. fluid resuscitation, blood transfusion etc
no antivirals are currently available

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68
Q

what is dengue fever caused by

A

Aedes aegypti mosquito

endemic in INDIA
7 days incubation

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69
Q

what is chlamydia caused by

A

Chlamydia trachomatis

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70
Q

ix chlamydia

A

NAAT
- for women: the vulvovaginal swab is first-line
- for men: the urine test is first-line (first void)
2 wks after poss exposure

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71
Q

chlamydia tx
1st line
if pregnant

A

1st line = doxycyline 7 days

if pregnant = azithromycin, erythromycin or amoxicillin

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72
Q

most common cause of viral meningitis

A

enteroviruses - coxsackie virus, echovirus

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73
Q

mx BV

A

asx = no tx
sx = oral metronidazole 5-7 days

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74
Q

criteria for BV dx

A

thin, white homogenous discharge
CLUE cells on microscopy: stippled vaginal epithelial cells
vaginal pH > 4.5
positive WHIFF test (addition of potassium hydroxide results in fishy odour)

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75
Q

leprosy causative organism

A

Mycobacterium leprae

76
Q

sx leprosy + what country can get it

A

endemic to certain areas of india

hypo-pigmented patches
loss of sensation in fingers + toes
thickening of peripheral nerves (ulnar)
thickening of skin on hands + face - leonine faces
muscle weakness

77
Q

leprosy tx

A

dapsone, rifampicin and clofazimine for 12–24 months

78
Q

test for all mycobacterium

A

Acid-fast bacillus (AFB) smears

79
Q

commonest bacterial cause of intestinal disease in UK

A

Campylobacter jejuni

80
Q

features campylobacter jejuni

A

faecal-oral route
incubation period = 1-6 days

prodrome: headache malaise
diarrhoea: often bloody
abdominal pain: may mimic appendicitis

81
Q

tx campylobacter jejuni

A

tx if severe / px immunocomp

clarithromycin
(or ciprofloxacin)

82
Q

comps of campylobacter jejuni

A

Guillain-Barre syndrome may follow Campylobacter jejuni infections
reactive arthritis
septicaemia, endocarditis, arthritis

83
Q

causes of meningitis 0-3months old

A

Group B Streptococcus (most common cause in neonates)
E. coli
Listeria monocytogenes

84
Q

causes of meningitis 3-6 yrs old

A

Neisseria meningitidis
Streptococcus pneumoniae
Haemophilus influenzae

85
Q

causes of meningitis 6-60 yrs old

A

Neisseria meningitidis
Streptococcus pneumoniae

86
Q

causes of meningitis >60 yrs old

A

Streptococcus pneumoniae
Neisseria meningitidis
Listeria monocytogenes

87
Q

causes of meningitis if immunosuppressed

A

Listeria monocytogenes

88
Q

e coli gram stain

A

gram negative bacilli

89
Q

Streptococcus pneumoniae gram stain

A

gram positive diplococci/chain

90
Q

H. influenzae gram stain

A

gram negative coccobacilli

91
Q

Listeria monocytogenes gram stain

A

gram positive rod

92
Q

Neisseria meningitis gram stain

A

gram negative diplococci

93
Q

Staphylococcal toxic shock syndrome dx criteria

A

fever: temperature > 38.9ºC
hypotension: systolic blood pressure < 90 mmHg
diffuse erythematous rash
desquamation of rash, especially of the palms and soles
involvement of three or more organ systems: e.g. gastrointestinal (diarrhoea and vomiting), mucous membrane erythema, renal failure, hepatitis, thrombocytopenia, CNS involvement (e.g. confusion)

94
Q

what test sld be offered to all px w TB

A

HIV

95
Q

difference between IgM and IgG

A

IgM raised 4-7 days after infection starts
iMmediately
IgG raised 7-14 days post-infection and are detected for weeks, months, even years later (if positive shows immunity)
Gradually

96
Q

examples of Encapsulated Bacteria

A

Streptococcus pneumoniae
Haemophilus influenzae
Meningococci

  • the spleen plays a central role in opsonizing and phagocytosing encapsulated bacteria
97
Q

what are howell-jolly bodys

A

pathognomonic for splenic dysfunction

98
Q

organism that causes syphilis

A

treponema pallidum

99
Q

serological tests for syphilis

A

non-treponemal tests
- non specific, can have false +ves
- assesses quantity of antibodies being produced
- becomes -ve after tx
- decreases over time
-VDRL or RPR

treponemal-specific tests
- more complex + expensive but specific
- ‘reactive’ or ‘non-reactive’
- always has TP in its name (eg TPHA or TPEIA)

100
Q

Causes of false positive non-treponemal (cardiolipin) tests

A

pregnancy
SLE, anti-phospholipid syndrome
tuberculosis
leprosy
malaria
HIV

101
Q

Positive non-treponemal test + positive treponemal test

A

consistent with active syphilis infection

102
Q

Positive non-treponemal test + negative treponemal test

A

consistent with a false-positive syphilis result e.g. due to pregnancy or SLE (see list above)

103
Q

Negative non-treponemal test + positive treponemal test :

A

consistent with successfully treated syphilis

104
Q

primary features of syphilis

A

chancre - painless ulcer at site of sexual contact
local non-tender lymphadenopathy
(often not seen in women)

105
Q

secondary features of syphilis

A

6-10 wks after primary infection

systemic sx: fevers, lymphadenopathy (not painful)
RASH on trunk, palms, soles
buccal ‘snail track’ ulcers
condylomata lata (painless, warty lesions on the genitalia)

106
Q

tertiary features of syphilis

A

gummas (granulomatous lesions of the skin + bones)
ascending aortic aneurysms
general paralysis of the insane
tabes dorsalis
Argyll-Robertson pupil (no reaction to light but do accomodation)

107
Q

features of congenital syphilis

A

blunted upper incisor teeth (Hutchinson’s teeth), ‘mulberry’ molars
rhagades (linear scars at the angle of the mouth)
keratitis
saber shins
saddle nose
deafness

108
Q

ebola incubation period

A

2 to 21 days

109
Q

sx ebola

A

sudden onset of fever fatigue, muscle pain, headache and sore throat.

This is followed by vomiting, diarrhoea, rash, symptoms of impaired kidney and liver function, and in some cases, both internal and external bleeding

110
Q

how is ebola spread

A

human-to-human transmission via direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids

111
Q

Most common organism found in central line infections

A

Staphylococcus epidermidis (as part of normal skin flora)

112
Q

1st line syphilis treatment

A

intramuscular BENZATHINE PENICILLIN

113
Q

causes of non-falciparum malaria

A

Plasmodium vivax most common
Plasmodium ovale
Plasmodium malariae
Plasmodium knowlesi

114
Q

features of non-falciparum malaria

A

general features of malaria: fever, headache, splenomegaly
Plasmodium vivax/ovale: cyclical fever every 48 hours. Plasmodium malariae: cyclical fever every 72 hours
Plasmodium malariae: is associated with nephrotic syndrome

Ovale and vivax malaria have a hypnozoite stage and may therefore relapse following treatment.

115
Q

tx of non-falciparum malaria

A

in areas which are known to be chloroquine-sensitive: either CHLOROQUINE or an artemisinin-based combination therapy (ACT)

in areas which are known to be chloroquine-resistant: an ACT (avoid in pregnant women)

patients with ovale or vivax malaria should be given PRIMAQUINE following acute treatment with chloroquine to destroy liver hypnozoites and prevent relapse

116
Q

how to differentiate between toxoplasmosis + primary CNS lymphoma in HIV px

A

toxoplasmosis:
- multiple lesions
- ring or nodular enhancement
- Thallium SPECT negative

lymphoma:
- single lesion
- solid (homogenous) enhancement
- Thallium SPECT positive

117
Q

presentation PCP

A

presents desaturation on exertion

often Chest x-ray appears normal

dyspnoea
dry cough
fever
very few chest signs

Pneumothorax is a common complication

118
Q

mx PCP

A

co-trimoxazole

119
Q

Pseudomonas aeruginosa lab features (+ gram stain)

A

Gram-negative rod
non-lactose fermenting
oxidase positive

120
Q

2 common bacteria that cause otitis externa

A

Pseudomonas aeruginosa
Staphylococcus aureus

121
Q

Gram -ve rods: CHEPS (rods like chips)

A

C. Jejuni
H. influenzae
E. Coli
Pseudomonas
Salmonella

Klebsiella pneumoniae

122
Q

features of trichomonas vaginalis

A

vaginal discharge: offensive, yellow/green, frothy
vulvovaginitis
strawberry cervix
pH > 4.5
in men is usually asymptomatic but may cause urethritis

123
Q

ix trichomonas vaginalis

A

microscopy of a wet mount shows motile trophozoites

124
Q

tx trichomonas vaginalis

A

oral metronidazole for 5-7 days, although the BNF also supports the use of a one-off dose of 2g metronidazole

125
Q

HIV post exposure prophylaxis

A

oral antiretroviral therapy for 4 weeks (should be initiated immediately after exposure but can be considered for up to 72 hours)

126
Q

complications of Mycoplasma pneumoniae

A

erythema multiforme (target lesions), nodosum

cold agglutins (IgM): may cause an AI haemolytic anaemia, thrombocytopenia

meningoencephalitis, GBS and other immune-mediated neurological diseases

bullous myringitis (painful vesicles on the tympanic membrane)

pericarditis/myocarditis

gastrointestinal: hepatitis, pancreatitis

renal: acute glomerulonephritis

127
Q

features of Mycoplasma pneumoniae

A

the disease typically has a prolonged and gradual onset

flu-like symptoms classically precede a dry cough

bilateral consolidation on x-ray

complications may occur

128
Q

ix Mycoplasma pneumoniae

A

diagnosis is generally by Mycoplasma SEROLOGY

positive cold agglutination test → peripheral blood smear may show red blood cell agglutination

129
Q

when to send a urine culture in LUT infection sx

A

aged > 65 years
visible or non-visible haematuria
men
pregnant

130
Q

bacteria in BV

A

Gardnerella vaginalis

131
Q

what is cellulitis

A

a bacterial infection that affects the dermis and the deeper subcutaneous tissues

132
Q

causes of celluliis

A

Streptococcus pyogenes
less commonly Staphylcoccus aureus

133
Q

features of cellulitis

A

commonly occurs on the shins
- usually unilateral - bilateral cellulitis is rare and suggests an alterative diagnosis

erythema
- generally reasonably well-defined margins but some cases may present with diffuse erythema
- blisters and bullae may be seen with more severe disease

swelling

systemic upset
- fever
- malaise
- nausea

CLINICAL DX

134
Q

classification for cellulitis

A

Eron classification

I = no signs of systemic toxicity, no uncontrolled co-morbidities

II = either systemically unwell or systemically well but with a co-morbidity (e.g. PAD chronic venous insufficiency, or morbid obesity) which may complicate or delay resolution of infection

III = significant systemic upset such as acute confusion, tachycardia, tachypnoea, hypotension, or unstable co-morbidities that may interfere with a response to treatment, or a limb-threatening infection due to vascular compromize

IV = sepsis syndrome or a severe life-threatening infection such as necrotizing fasciitis

135
Q

who with cellulitis to admit for IV abx

A

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

136
Q

mx cellulitis according to classification

A

Eron Class I
- oral FLUCLOXACILLIN as first-line treatment for mild/moderate cellulitis
- oral clarithromycin, ERYTHROMYCIN (in pregnancy) or doxycycline is recommended in patients allergic to penicillin

Eron Class II
- NICE recommend: ‘Admission may not be necessary if the facilities and expertise are available in the community to give intravenous antibiotics and monitor the person - check local guidelines.’

Eron Class III-IV
- admit
- NICE recommend: oral/IV co-amoxiclav, oral/IV clindamycin, IV cefuroxime or IV ceftriaxone

137
Q

features of gonorrhoea

A

males: urethral discharge, dysuria
females: cervicitis e.g. leading to vaginal discharge
rectal and pharyngeal infection is usually asymptomatic

138
Q

mx gonorrhoea

A

single dose of IM ceftriaxone 1g

If sensitivities are known (and the organism is sensitive to ciprofloxacin) then a single dose of oral ciprofloxacin 500mg should be given

139
Q

what is the Jarisch-Herxheimer reaction

A

sometimes seen following tx of syphilis

-> fever, rash, tachycardia after 1st dose of abx

(no wheeze/hypotension differentiating it from anaphylaxis)
no treatment is needed other than antipyretics

140
Q

what to monitor to asses response to syphilis tx

A

nontreponemal (rapid plasma reagin [RPR] or Venereal Disease Research Laboratory [VDRL]) titres should be monitored after treatment to assess the response

a fourfold decline in titres (e.g. 1:16 → 1:4 or 1:32 → 1:8)is often considered an adequate response to treatment

141
Q

ix lyme disease

A

can be diagnosed clinically if erythema migrans is present

enzyme-linked immunosorbent assay (ELISA) antibodies to Borrelia burgdorferi are the first-line test

142
Q

Botulism features

A

patient usually fully conscious with no sensory disturbance
flaccid paralysis
diplopia
ataxia
bulbar palsy

143
Q

Clostridium botulinum

A

gram positive anaerobic bacillus
7 serotypes A-G
produces botulinum toxin, a neurotoxin which irreversibly blocks the release of acetylcholine
may result from eating contaminated food (e.g. tinned) or intravenous drug use
neurotoxin often affects bulbar muscles and autonomic nervous system

144
Q

tx botulism

A

botulism antitoxin (only effective if given early) and supportive care

145
Q

extra features of infectious mononucleosis (glandular fever)

A

palatal petechiae
splenomegaly - predisposes to rupture
hepatitis - transient rise in ALT
lymphocytosis
haemolytic anaemia secondary to cold agglutins (IgM)

146
Q

what happens to some px who take penicillins w infectious mononucleosis (glandular fever)

A

a maculopapular, pruritic rash develops in around 99% of patients

147
Q

what organism causes TSS

A

staph aureus

148
Q

sx mumps

A

fever
malaise, muscular pain
parotitis (earache, pain on eating) - unilateral initially then becomes bilateral in 70%

149
Q

comps of mumps

A

orchitis - uncommon in pre-pubertal males but occurs in around 25-35% of post-pubertal males. Typically occurs four or five days after the start of parotitis
hearing loss - usually unilateral and transient
meningoencephalitis
pancreatitis

150
Q

malignancies assoc w EBV infection

A

Burkitt’s lymphoma*
Hodgkin’s lymphoma
nasopharyngeal carcinoma
HIV-associated central nervous system lymphomas

151
Q

Characteristic features of pneumococcal pneumonia (strep pneumoniae)

A

rapid onset
high fever
pleuritic chest pain
herpes labialis (cold sores)

152
Q

cause of bronchiolitis

A

RSV

153
Q

cause of croup

A

parainfluenza

154
Q

cause of common cold

A

rhinovirus

155
Q

cause of flu

A

influenza virus

156
Q

most common cause of CAP

A

Streptococcus pneumoniae

157
Q

Most common cause of bronchiectasis exacerbations

A

Haemophilus influenzae

158
Q

cause of epiglottitis

A

Haemophilus influenzae

159
Q

what is the most common, most severe type of malaria

A

Falciparum malaria

160
Q

clinical features + comps of severe malaria

A

schizonts on a blood film
parasitaemia > 2%
hypoglycaemia
acidosis
temperature > 39 °C
severe anaemia

Complications
cerebral malaria: seizures, coma
acute renal failure: blackwater fever, secondary to intravascular haemolysis, mechanism unknown
acute respiratory distress syndrome (ARDS)
disseminated intravascular coagulation (DIC)

161
Q

comps of malaria

A

cerebral malaria: seizures, coma
acute renal failure: blackwater fever, secondary to intravascular haemolysis, mechanism unknown
acute respiratory distress syndrome (ARDS)
hypoglycaemia
disseminated intravascular coagulation (DIC)

162
Q

cause of conjunctivitis

A

adenovirus

163
Q

what does the mantoux test test for

A

LATENT TB

164
Q

what can cause a false negative mantoux test

A

TB
AIDS
Long-term steroid use
Lymphoma
Sarcoidosis
Extremes of age
Fever
Hypoalbuminaemia
Anaemia

165
Q

when would you use a molecular assay in TB

A

detects if rifampicin resistant

166
Q

isolation time for c diff

A

48 hrs

167
Q

Toxoplasmosis infection in healthy px

A

Most infections are asymptomatic. Symptomatic patients usually have a self-limiting infection, often having clinical features resembling infectious mononucleosis (fever, malaise, lymphadenopathy).

168
Q

dx toxoplasmosis

A

serology

if immunocomp + cerebral
CT = usually single or multiple ring-enhancing lesions, mass effect may be seen

169
Q

toxoplasmosis in immunocomp px

A

Cerebral toxoplasmosis accounts for around 50% of cerebral lesions in patients with HIV
constitutional symptoms, headache, confusion, drowsiness

170
Q

mx of cerebral toxoplasmosis

A

pyrimethamine plus sulphadiazine for at least 6 weeks

171
Q

Disseminated gonococcal infection triad

A

tenosynovitis, migratory polyarthritis, dermatitis

172
Q

live attenuated vaccines

A

BCG
MMR
oral polio
yellow fever
oral typhoid

173
Q

yellow fever presentation

A

sudden onset of high fever, rigors, nausea & vomiting. Bradycardia may develop. A brief period of remission (THIS IS KEY) is followed by jaundice, haematemesis, oliguria

174
Q

typhoid features

A

fever, myalgia, and constipation

175
Q

what is lassa fever

A

viral haemorrhagic fever

endemic in West Africa

176
Q

bacteria to be worries about post splenectomy (may cause sepsis)

A

encapsulated bacteria

Strep Pneumonia
Haemophilus influenzae
Neisseria Meningitiditis

177
Q

whats sld px w hyposplenism be vaccinated against

A

pneumococcal, Haemophilus type B and meningococcus type C

178
Q

typhoid fever presentation (Salmonella typhi)

A

initially systemic upset
relative bradycardia
abdominal pain, distension
constipation: although Salmonella is a recognised cause of diarrhoea, constipation is more common in typhoid
rose spots: present on the trunk in 40% of patients, and are more common in paratyphoid

179
Q

key for Leptospirosis

A

spread by rat urine
- commonly seen in questions referring to sewage workers, farmers, vets or people who work in an abattoir

180
Q

specific sign for gas gangrene

A

crepitus on palpation

181
Q

most common infective cause of diarrhoea in patients with HIV

A

Cryptosporidium parvum - protozoa

182
Q

Most common organism found in central line infections

A

Staphylococcus epidermidis

183
Q

abx to give to uti if breastfeeding

A

Trimethoprim - present in mil but fine short term

Nitrofurantoin should be avoided when breastfeeding - small amounts in milk but can cause haemolysis in G6PD infants.

184
Q

what bacteria is acute food poisoning most commonly caused by

A

Staphylococcus aureus, Bacillus cereus or Clostridium perfringens

185
Q

what does dx of kaposi’s sarcoma suggest + how may it present

A

HIV infection

Raised purple lesions

finals (27 decks)

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