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Its the final countdown > infectious disease > Flashcards

infectious disease Flashcards

1
Q

Pt presents with Nonspecific fever, myalgia and erythema migraines. What is the 1st line medication and duration for management ?

A

Doxyclycline
2-3 weeks

Erythema migrans = bullseye rash
Lyme disease is endemic I northern Europe

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2
Q

A normally fit and well pt presents at ES with vomiting and non-bloody diarrhoea. During the Hx she mentioned eating reheated rice and curry the night before. She is appyrexial. What is the lost likely cause?

A

Bacillus cereus

Think cereus - cereal (e.g. cocopops). Bacillus cereus
- 30mins - 6hrs post food
- profuse vomiting
- Apyrexial

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3
Q

22 yo male presents with 1wk sore throat & fatigue. On examination, he has Tonsillitis enlargement with exudate

Lab results show elevated liver enzymes and positive heterophike antibody test

What is the most likely causenof the presentation

A

EBV - mono

Mono presentation: young adults, sore throat, fatigue, LYMPHADENOPATHY, HEPATOSPLENOMEGALY (hence elevated liver enzymes), and rash

Ix -
Elevated liver enzymes
Leukocytes
Positive heterophile antibody test = moonspot test

Tx - supportive: rest, hydration, paracetamol

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4
Q

What is the heterophile antibody test also known as.

What infective organism causes a positive finding?

A

Heterophile antibody test = Monospot test

Positive in EBV infection

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5
Q

Potts disease aka […]
Is found in what condition?

What are
- clinical features
- Xray
- biopsy

A

Potts disease of the spine = tuberculosis spondylitis ( extrapulmonary manifestation of TB)

Clinical features: localised back pain, neurological deficits
Xray: vertebral body involvement (e.g. reduction of vertebral height)
Biopsy: granuloma

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6
Q

Cholera mx

A

Aggressive fluid resus - IV Hartmanns
Abx - Doxyclcije / Co- trimoxazole

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7
Q

When should pts with Whooping cough be admitted into hospital

A

If <6m old / sig. Resp sx or complications

Otherwise supportive/ symptomatic management
Can use macrolides, to reduce infectivity but doesn’t affect condition

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8
Q

When should pts with Whooping cough be admitted into hospital

A

If <6m old / sig. Resp sx or complications

Otherwise supportive/ symptomatic management
Can use macrolides, to reduce infectivity but doesn’t affect condition

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9
Q

What is the treatment for pt who presents with vaginal discharge and a fishy odour.

She is sexually active but uses barrier protection with one longterm partner

A

Bacterial vaginosis - imbalance of microbiome –> overgrowth of anaerobic bacteria & loss of lactobacilli

1 risk factor: smoking

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10
Q

What are the features of Amsel criteria?

A

Amwell criteria - used to diagnose bacterial vaginitis

Vag pH >4.5
Homogenous grey/ Milky discharge
Positive whiff test
Clue cells

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11
Q

Tx in Bacterial vaginosis

A

Metronidazole or clindamycin

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12
Q

describe Mhycobacterium tuberculosis

  • appearance
  • what stain is used
  • what is the finding on the staining
A

M. tuberculosis

small rod-shaped bacillus

Ziehl-Neelsen stain: bright red against blue backrground

( m. tuberculosis is an acid-fast bacillius - as waxy coating makes them resistant to acids)

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13
Q

TB is spread through inhaling saliva droplets from infected people. in most cases its cleared, what are the 4 stages of TB in patients in which it remains

A

Primary active TB
Latent TB (immune system encapsulates bacteria, progression does not occur in most patients)
Secondary TB (typically in immunosuppresion)
Miliary TB - disseminated & severe disease

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14
Q

what test is conducted prior to giving the BCG vaccine

A

Mantoux test ( -ve = <5cm bleb growth on skin after injecting the proteins)

check for immunosuppression( vaccine live)

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15
Q

In addition to culturing the bacteria, what Ix can be conducted in

  • latent or active TB
  • active disease alone
A

latent/ active
- mantoux test
- interferon-gamma release assay

  • active
    CXR
    cultures
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16
Q

what are the chest X-ray findings in
-primary TB
- secondary TB
- Miliary TB

A

primary
- patchy consolidation
- pleural effusions
- hilar lymphadenopathy

secondary
- patchy/nodular consolidation with cavitation ( gas-filled space)

miliary TB
- appearance of millet seeds (many small nodules disseminated throughout lung fields) uniformly distributed acoss ung fields

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17
Q

Medication and duration for latent TB

A

isoniazid & rifampicin - 3m
OR

isoniazid - 6m

(active TB 6:RI, 2:PE)

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18
Q

what medication should be co-presribed with the RIPE regime?

A

Vitamind B6 (pyridoxine)

Isoniazid –> peripheral neuropathy

this is prevented by Vi B6

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19
Q

what micro-organism causes lyme disease

A

borrelia burgdoferi ( transmitted by ixodes tics)

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20
Q

3 key Sx which indicate nephritic syndrome

A

HTN, haematuria and oedema

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21
Q

3 findings of nephrotic syndrome

A

ne-frothy urine

  • protein urea
    *hyperlipidaemia
  • hypoalbunaemia
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22
Q

most common cause of nephritic syndrime

A

Post-strep glomerulonephritis ( if throat/skin infection 1-3 weeks prior)

other: IgA nephropathy

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23
Q

name the medication used to treat TB

A

Rifampicin
isoniazid
pyrazinamide
ethambutol

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24
Q

A pt completes 6months of the RIPE regiem and starts complaining of bilateral lower limb numbness, and intermittent paraesthesia .

what S/E is he suffering from?
what medication should he be Rx?

A

S/E: peripheral neuropathy (isoniazid)
Rx: Vit B6 should be co-prescribed to prevent depletion

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25
Q

A pt completes 6months of the RIPE regiem and starts complaining of bilateral lower limb numbness, and intermittent paraesthesia .

what S/E is he suffering from?
what medication should he be Rx?

A

S/E: peripheral neuropathy (isoniazid)
Rx: Vit B6 should be co-prescribed to prevent depletion

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26
Q

A 2-year-old girl presents to her GP with a 10-day history of a cough, sore throat and mild fever. For the last 2 nights, the cough started to take on a ‘dry, hacking’ quality. She has a continuous cough with short interspersed high-pitched gasps for breath. .

what is the most likely responsible organism?

A

Bordetella Pertussis

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27
Q

what is the most common cause of urethritis in males?
(condition, causative organism)

A

gonorrhoeae

N. gonorrhoeae

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28
Q

what is the main ophthalmic S/E of one of the TB medications?

A

vision disturbance (esp. red-green colour detection)
ethambutol

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29
Q

what type of bacteria (e.g g+ve/egative, rod etc) causes the most common cause of urethritis in males

A

G-ve diplococcus

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30
Q

what are the findings in CSF of viral meningitis
- lymphocytes/neutrophils
- protein count
- glucose level

A

viral meningitis: lymphocytes, slightly raised protein count, normal glucose

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31
Q

name and describe the presentation of the organism which causes TB

A

mycobacterium tuberculosis

small, rod-shaped bacteria (bascillus)

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32
Q

what stain is used in TB

what colour does M. tuberculosis tunr

A

Ziehl-Neelsen stain

Red against a blue background

TB = acid-fast basiclli

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33
Q

A patient attends with a chronic cough and night sweats.

Sputum culture grows acid-fast bacilli that stain red with the Zeihl-Neelsen staining. what condition do you suspect

A

TB

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34
Q

describe the 4 outcomes of TB
1. most likely
2. primary active TB
3. latent TB
4. secondary TB

A

most cases: Immediate clearance of the bacteria
* Primary active TB - active infection after exposure
* Latent tuberculosis ASx & non-contagious presence of the bacteria
* Secondary tuberculosis (reactivation of latent TB to active infection)

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35
Q

what tests need to be conducted before providingthe BCG vaccine

A

Mantoux test ( can give vaccine if -ve)

assess for immunosuppression

assess for HIV

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36
Q

24 yo male presents pyrexic, bilateral jaw pain and parotid swelling. what complication is he most likely to get

A

orchitis

presentation - mumps ( parotid swelling = mumps)
in post-pubescent males, the most likely complication is orchitis

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37
Q

what is the difference between cellulitis and erysipelas

A

cellulitis - dermis and subcut infection

eyrysipelas - dermis and upper subcut tissue

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38
Q

2 causes of cellulitis / erysipelas

A

GAS
Staph. aureus

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39
Q
A
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40
Q

1st line in cellulitis/ erysipelas

mild-mod

severe

A

mild-mod: fluclox

severe: flucloxacillin + benzylpenicillin

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41
Q

2nd line in cellulitis

A

clarithromycin/ clindamycin

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42
Q

2nd line in erysipelas

A

erythromycin

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43
Q

signs and symptoms

A
  • Pain disproportionate to clinical signs.
  • Mild inflammation of the overlying skin at the initial stages.
  • Crepitus upon palpation and potential visibility of gas on imaging (in gas-forming organisms).
  • skin changes: dark discoloration, blistering, and necrosis.
  • Pain subsides (nerve damage).
  • Widespread oedema (beyond the area of erythema).
  • Systemic illness (fever, tachycardia, tachypnoea, and hypotension).
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44
Q

describe the types of necrotising fasciitis

A

3 types

  • Type 1: polymicrobial, (anaerobes).
  • Type 2: monomicrobial, (GAS/ Staph. aureus) .
  • Type 3: gas-forming organisms such as Clostridium perfringens –> ‘gas gangrene’. (gas gangrene = muscle tissue & lots of gas, nec. fasc. is fascia, not muscle tissue)
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45
Q

3 aspects of Mx in nec. fasc

A

Surgical debridement ( immediate - amputation where necessary)

Broad spec Abx (IV clindamycin/meropenem/ vancomycin)

haemodynamic support

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46
Q

which form of HIV is most commonly found in west africa

A

HIV-2

(HIV-1 is the most common type)

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47
Q

what immune cells do the HIV viruses enter

A

CD4 T-helper cells

48
Q

AIDS-defining illnesses occured when the CD4 count is low enough to allow for opportunistic infections/malignancies. give 6 examples of AID-defining illnesses

A

Kaposi’s sarcoma

Pneumocystitis jirovecii pneumonia

CMV

Candidiasis

Lymphomas

TB

e.g. “A pts CD4 count is 180/mm3, what medication should be added to his anti-virals? Co-trimoxazole” - due to PCP risk (* Under 200 cells/mm3 puts the patient at high risk of opportunistic infections)

49
Q

normal CD4 t-helper cell range

A
  • 500-1200 cells/mm3
50
Q

under what CD4 t-helper cell level are HIV patients at high risks of opportunistic infections

A

under 200 cells/mm3

51
Q

give an example of antiretroviral therapy

A

combo of meds given to all with HIV status, despite CD4 count/ Viral load

(e.g., tenofovir plus emtricitabine) plus a third agent (e.g., bictegravir).

52
Q

what medication should be given in addition to ART in HIV positive patients with a CD4 count under 200/mm3

A

co-trimoxazole

PCP protection

53
Q

what should be the mode of delivery in a viral load of <50copies/ml during labour?

A

normal vaginal

54
Q

what should be the mode of delivery in a viral load of >50copies/ml during labour?

A

consider pre-labour C-section

55
Q

what should be the mode of delivery in a viral load of >400copies/ml during labour?

A

Pre-labour c-section

56
Q

what medication is given as an infusion during labour if the mother’s viral load is unknown/ above 1000copies/ml

A

IV Zidovudine

57
Q

what HIV prophylaxifs is given to babies who’s maternal viral load is <50copes/ml ( low risk babies)

A

zidovudine (2-4wks)

58
Q

what HIV prophylaxis is given to babies who’s maternal viral load is high ( highrisk babies)

A

zidovudine & lamivudine & nevirapine 4 wks

59
Q

Breastfeeding in HIV

A

should be avoided, inspite of low viral load

can be done but needs close monitoring

60
Q

within what time window should PEP be taken

A

<72hrs

61
Q

What medications make up PEP (post exposure prophylaxis - HIV) ?

A

raltegravire, & emtricitabine/tenofovir ( Truvada)

62
Q

what medications make up PrEP ( pre-exposure prophylaxis)

A

emtricitabine/tenofovir (truvada)

63
Q

what is the most common opportunistic infection in HIV

A

Pneumocystis jiroveci pneumonia

64
Q

presentation of pneumocystitis jirovecii pneumonia (x4)

A

Dyspnoaea, dry cough, fever, very few chest signs

65
Q

what is a common complication of the most common opporunistic infection in HIV

A

pneumothorax

(PCP is the most common opportunistic infection)

66
Q

what is typical of the oxygen sats in PCP?

A

exercise induced desaturation

67
Q

Mx of PCP

A

cotrimoxazole

IV pentamidine in severe cases

steroids in hypoxia/ prevention of respiratory failure

68
Q

what causes toxic shock syndrome

A

exotoxins from

GAS,Staph, MRSA

69
Q

what is the presentation for toxic shock syndrome (x3)

A

fever >38.9
SB <90
multiple system involvement (GI, CNS, Skin )

flu-like sx (possibly nausea & vom)–> high fever –> widespread macular rash

70
Q

Mx toxic shock syndrome

A

DR ABCDE, aggressive fluid & electrolyte resus, Abx

Tx infection
- attending to source
IV Abx: Clindamycin +)cephalosporin/meropenem/vancomycin)

surgical: debridement/drainage/ amputation

71
Q

Tx syphilis

1st line
2nd line

A

deep IM benzathine benzylpenicillin (or cef/amoxicillin/dox)

doxyclycline

72
Q

Jarish Herxheimer reaction

A

reaction to syphilis tx
( fever, rash tachy ( but no wheeze/ hypotension as in anaphylaxis) )

tx - antipyretcs if required

73
Q

what family of parasites causes malaria

A

plasmodium family

protozoan parasites - singlye celled- organisms

74
Q

the most common ( in the UK) and most dangerous type of malaria-causign parasite

A

Plasmodium falciparum

75
Q

Sporoziotes (malaria spores) are injected by a mosquio and lay dormant in what part of the body

A

the liver

lay dormant/ mature in the liver –> then spread to RBCs –> rupture & more spread –> haemolytic anaemia

76
Q

typical history in patient who has malaria ( location, duration)

A

travelled to an area with malaria
1-4weeks after ( this is incubation period)

*may be incubated for 4 years (P.vivax and P.ovale) - so travel Hx is important

77
Q

Sx malaria

A

high fever (up to 41 degrees) w/ sweats & rigors

fatigue and myalgia

headaches

N&V

  • high fever, spikes every 48hrs = malaria
78
Q

examination findings in malaria (x3)

A

think, it causes haemolytic anaemia
pallor
hepatosplenomegaly
jaundice

79
Q

what investigation is used to diagnose malaria and what are the diagnostic findings

A

malaria blood film

  • parasites
  • concentration of parasites (>2% RBC involved = severe)
  • type
80
Q

a malaria blood film is conducted on a patient and appears negative. What is the appropriate next step?

A

conduct 2 more in the next 2 days

3 -ve samples on 3 consecutive days are needed to exclude malaria

parasites are released from RBC every 42-78 hrs (hence spike in fever every 48hrs being typical in malaria), so 3 consecutive measurements should capture the cell rupture & release of parasites

81
Q

1st line management for malaria

A

Riamet ( artemether with lumefantrine)

others: Quinine (+ doxycycline/ clindamycine), proquanil with atovaquone, chloroquine, primaquine

(artesunate and quinine are most important to remember

82
Q

to what antimalarial drug is there increasing drug resistance

A

chloroquine

83
Q

which antimalarial can cause severe haemolysis in G6PD pts

A

primaquine

84
Q

what are the preventative options against malaria

A

none are 100% effective alone, so combine:

mosquito spray, nets/ barriers, antimalarial medication

85
Q

what are the main antimalarial options for preventing malaria

A

Malarone (Proguanil / atovaquone) - more expensive but less SE.
take: from 2days before travel to 7 days after travel

Doxycycline - broad-spec abx. S/E: diarrhoea, thrush, skin sensitivity to sunlight
take: 2days pre travel until 4weeksafter travel

Mefloquine - S/E psych (anxiety, depression, abnormal dreams)
take: 2weeks before until four weeks after travel to an endemic area

86
Q

most common cause of gastroentertitis

A

viral

87
Q

one important things to do when an inpatient has viral gastroenteritis

A

isolate them ( spreads easily)

88
Q

give 3 viral causes of gastroenteritis

A

Rotavirus
norovirus
adenovirus

89
Q

abdominal cramps, bloody diarrhoea and vomit after eating an unwashedsalad indicates which infective cause

A

E. coli

cause - shiga toxin, which destroys blood cells –> causes HUS

90
Q

what medical intervention increases chance of HUS in patient with E.Colki/ Shigella gastroenteritis

A

antibiotics

so avoid Abx if this is/ might be the cause

91
Q

bacteria under a microscope

E.coli
Campylobacter jejuni

A

E.coli
G-ve rod shaped bacillus

Campylobacter jejuni
G-ve curve/spiral shaped bacteria

Bacillus cereus
G+ve rod (G+ve unlike the others)

Yersinia Enterocolitica
G-ve bacillus

92
Q

what is the incubation period of C. Jejuni

A

1-6days

Sx resolve after 3-6 days

93
Q

what organisms cause a bloody diarrhoea

A

E.coli

C. jejuni - prodrome headache/ malaise, appendicitis- like abdo pain

Shigella - incubation period of 1-2 days

salmonella - watery diarrhoae , blood/mucus maybe in stool

94
Q

Mx in C. Jejuni
- normally
- in severe / immunosuppressed cases

A

normally - self-limiting

severe/ immunosuppressed
1st. clarithromycin
2nd ciprofloxacin/ Azithromhycin

95
Q

give 3 complications of C. Jejuni gastroenteritis

A
  1. GBS
  2. ReA
  3. endocarditis
  4. Arthritis
  5. septicaemia
96
Q

what is the incubation period of shigella

A

1-2 days

Sx resolve in 7 days

97
Q

incubation period for salmonella

A

12hrs - 3days

resolves <7days

98
Q

watery diarrhoea, abdo pain and vomitting suggests which infective organism

A

salmonella

stool may have mucus/blood

99
Q

salmonella gastroenteritis Mx

A

self-limiting
Abx folowing MC&S if severe

100
Q

what is the incubation period of Bacillus cereus

A

<5hrs

> 5hrs - crampy abdo pain & vomiting
8hrs - watery diarrhoea ( like salmonella, but shorter incubation period)
<24hrs - resolves

101
Q

what bacteria is commonly associated with eating raw/ undercooked pork

A

Yersinia enterocolita - carried by pigs

102
Q

what parasitic cause of gastroenteritis is acquired through contact with animals

A

Giardia lmblia - small intestines of animals ( pets, farm animals, humans

103
Q

what are the post gastroenteritis complications

A
  • Lactose intolerance
  • Irritable bowel syndrome
  • Reactive arthritis
  • Guillain–Barré syndrome
  • Haemolytic uraemic syndrome
104
Q

Ix in Giardiasis

A

NAAT/ EIA stool testing

105
Q

Mx in Giardiasis

A

tiniodazole or metronidazole

106
Q

define sepsis

A

SIRS ( systemic inflammatory response syndrome ) to infection

107
Q

what 2 measurements’ valuessa re used to diagnmose septic shock

A
  • Low mean arterial pressure (<65 mmHg) despite fluid resuscitation (requiring vasopressors)
  • Raised serum lactate (> 2 mmol/L)
108
Q

what score is used to assess the severity of organ dysfunction in sepsis

A

SOFA
sepsis-related organ failure assessment

  • Hypoxia
  • Increased oxygen requirements
  • Requiring mechanical ventilation
  • Low platelets (thrombocytopenia)
  • Reduce Glasgow Coma Scale (GCS)
  • Raised bilirubin
  • Reduce blood pressure
  • Raised creatinine
109
Q

what group of septic patients may present with normal observations?

A

neutropenic/ immunisuppressed

110
Q

what bloods should be conducted in sepsis

A

FBC - WCC & Neutrophils
U&Es - kidney function & AKI
LFTs - liver function, ?source of infection
CRP - inflammation
BM - hyper/hypoglycaemia
Clotting - ?DIC (thrombocytopenia and haemorrhage)
Blood cultures - ?bacteraemia
blood gass - lactate, pH, glucose

111
Q

how quickly from presentation should a patient with suspected sepsis be managed

A

<1hr

112
Q

what is the neutrophil count in a person with neutropenic sepsis

A

<1 x 10-9/L

113
Q

what medications may cause neutropenia

A

Oncology
- chemotherapy
- Rituxumab ( autoimmune/ cancer)
- inflixamab ( autoimmune)

Psych - schizophrenia
- clozapine

MSK - RA
- Hydroxychloroquine
- Sulfasalazine
- Methotrexate

Endo - hyperthryroidism
- Carbimazole

Infectious disease - Malaria
- Quinine

114
Q

what is the temp threshold for suspecting neutropenic sepsis in a patient with on chemo/ other meds which may cause neutropenia

A

38 oC

115
Q

what is the Management in neutropenic sepsis

A

Sepsis 6
Broad-spec antibiotic ( Tazocin)
close monitoring, .low threshold for escalation

116
Q

what is the incubation period

Staph aureus/ bacillus cereus
Salmonella/ E.coli
Shigella/ C. Jejuni
Giardiasis/ Amoebiasis

A

Incubation period
Staph aureus/ bacillus cereus : 1-6hrs
Salmonella/ E.coli: 12-48hrs
Shigella/ C. Jejuni 48-72hrs
Giardiasis/ Amoebiasis: >72hrs

Its the final countdown (23 decks)

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