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MRCP - Passmed > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

Pneumonia + blood smear (red cell agglutination) - organism?

A

Mycoplasma pneumoniae

IgM ab against the bug react against RBCs at cold temp -> haemolytic anaemia

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2
Q

Why do you get continuous motor spasms with tetanus toxin (tetanospasmin)?

A

Blockage of inhibitory neurotransmitters GABA and Glycine

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3
Q

Pruritic rash on the buttocks or soles

GI - diarrhoea + abdo pain / bloating

Organism? method of infection?

A

Strongyloides stercoralis - penetrates the skin

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4
Q

How do penicillins and cephalosphorins work?

A

Inhibit cell wall formation (beta-lactams)

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5
Q

Mx of Leigonella?

A

Macrolides - erythromycin / clarithromycin

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6
Q

Measles transmission?

A

Aerosol transmission

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7
Q

Mx of chlamydia? what if pregnant?

A

7d Doxycycline (If CI Azithromycin)

If pregnant:
- Azithromycin, erythromycin or amoxicillin

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8
Q

A history of Intravenous drug use coupled with a descending paralysis, diplopia and bulbar palsy is characteristic of infection with ……

A

Clostridium botulinum

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9
Q

Mx of UTI in pregnancy?

A

Nitro unless close to term

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10
Q

What are the features of Japanese encephalitis?

A

Headaches, fever, seizures and confusion

Parkinsonian features suggest basal ganglia involvement

Can also present with flaccid paralysis

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10
Q

Mx of C. Jejuni infection?

A

Clarithromycin

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11
Q

What medication should should all patients with CD4 <200/mm3 recieve?

A

Prophylaxis against Pneumocys

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12
Q

What are some characteristic features of pneumococcal pneumonia? (strep pneumo)

A

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

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13
Q

Ciprofloxacin increases the risk of which infection?

A

MRSA

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14
Q

Draw and learn the Gram +ve bacteria diagram

A

Yes please!

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15
Q

Bilateral conjunctivitis, bilateral calf pains and high fevers in a sewage worker

Organism? mx?

A

Leptospirosis

Mx: High dose benzylpenicillin / doxycycline

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16
Q

Trypanosoma cruzi, causes what disease? what is the most frequent and severe complication? other complications?

A

Chagas disease

Dilated cardiomyopathy (due to myocarditis + can also have arrhythmias)

GI features - Megaoesophagus + Megacolon -> constipation and dysphagia

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17
Q

Investigations for Lyme disease?

A

ELISA 1st

If +ve or equivocal -> immunoblot test (western blot)

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18
Q

gram-negative diplococci that can be identified on gram staining

Organism?

A

Neisseria gonorrhoea

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19
Q

What can occur in lung cavity from prev TB?

A

Aspergilloma

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20
Q

How do macrolides work? What are some adverse effects?

A

Inhibit the 50S subunit of ribosomes

Adverse:
- Nausea (esp erythromycin)
- P450 inhibitor
- Prolonged QT interval

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21
Q

Most common cause of bladder calcification? mx?

A

Schistosomiasis is the most common cause of bladder calcification worldwide

Schistosoma haematobium causes haematuria

mx: single oral dose of praziquantel

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22
Q

Which vaccines are live attenuated and hence CI in those on immunosupressive therapy

A

BCG
measles, mumps, rubella (MMR)
influenza (intranasal)
oral rotavirus
oral polio
yellow fever
oral typhoid

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23
Q

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

Suggestive of which organism infection? mx?

A

Trichomonas vaginalis

Mx: oral metronidazole 5-7d or 1 dose 2g

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24
Q

Most common cause of central line infections?

A

Staph epidermis

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25
Q

Features of severe malaria falciparum?

A

Feature of severe falciparum malaria
schizonts on a blood film
parasitaemia > 2%
hypoglycaemia
acidosis
temperature > 39 °C
severe anaemia
complications as below

Complications
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)

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26
Q

Which bacteria are gram +ve cocci and which are gram -ve cocci?

A

Gram-positive cocci = staphylococci + streptococci (including enterococci)

Gram-negative cocci = Neisseria meningitidis + Neisseria gonorrhoeae, also Moraxella catarrhalis

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27
Q

Which bacteria are Gram +ve rods (bacilli)

A

mnemonic = ABCD L

Actinomyces
Bacillus anthracis (anthrax)
Clostridium
Diphtheria: Corynebacterium diphtheriae
Listeria monocytogenes

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28
Q

Some examples of Gram -ve rods?

A

CHESS P

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

Pseudomonas aeurginosa

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29
Q

black eschar that is typically painless

Organism / infection? mx?

A

Anthrax - Bacillus anthracis

Mx: Ciprofloxacin

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30
Q

What is an alternative for PCP mx? Issues with this?

A

Aersolised pentamidine - less effective and risk of pneumothorax

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31
Q

Most commonly isolated organism from animal bites?

A

Pasteurella multocida

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32
Q

What is Q fever caused by? how does this present?

A

Coxiella burnetti

No rash but causes pneumonia

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33
Q

Gram+ve organism in clusters
Coagulase -ve

Causes UTI - which group esp?

A

Esp in young sexually active women

Staph saprophyticus

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34
Q

What can cause IDA in patients returning from travel to endemic regions (eg indian subcontinent)

A

Hookworms

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35
Q

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

Diagnosis?

A

Dengue

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36
Q

Abx of choice for animal bites?

A

Co-amox

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37
Q

What malignancies are associated with EBV?

A

Burkitt’s lymphoma
Hodgkin’s lymphoma
nasopharyngeal carcinoma

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38
Q

What does atypical lymphocytes on blood film suggest?

A

Glandular fever

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39
Q

What is Kaposi sarcoma caused by?

A

HHV-8 (human herpes virus 8)

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40
Q

Describe LP findings in Viral meningitis:

A

Opening pressure - normal
Cell count - raised
Cell differential - Lymphocytes
Glucose - Normal / 2/3 of serum levels
Protein - within normal range / raised

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41
Q

depigmentation and loss of sensation

Infectious cause?

A

Leprosy

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42
Q

Gram-positive cocci in clusters, which are coagulase positive

Organism?

A

Staphylococcus aureus

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43
Q

Mx of toxoplasmosis inn immunocompromised patients?

A

pyrimethamine plus sulphadiazine

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44
Q

Abx recommended for animal and human bites?

A

Co-amox

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45
Q

What are some examples of live attenutated vaccines which should be not recommended for those with weakened immune systems?

A

MY BOOTI

MMR
Yellow

BCG
Oral poilo
Oral rotavirus
Typhoid oral
Influenza intranasal

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46
Q

Severe vomiting
Short incubation period

suggestive of which cause of gastroenteritis?

A

Staph aureus

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47
Q

Hep E - risk is associated with what? how is it spread?

A

Faecal-oral spread, commonly affecting shellfish and pork products

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48
Q

Mx of PCP?

A

co-trimoxazole
IV pentamidine in severe cases

aerosolized pentamidine is an alternative treatment for Pneumocystis jiroveci pneumonia but is less effective with a risk of pneumothorax

steroids if hypoxic (if pO2 < 9.3kPa then steroids reduce risk of respiratory failure by 50% and death by a third)

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49
Q

Why is primaquine used in mx of non-falciparum malaria?

A

Destroy liver hypnozoites and prevent relapse

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50
Q

Mx of Lyme disease?

A

Doxycycline if early disease - amox if CI eg pregnancy

Ceftriaxione if disseminated disease

51
Q

lower back pain, fever, myalgia, fatigue, jaundice and a subconjunctival haemorrhage.

in a sewage worker - suggestive of which disease?

A

Leptospirosis

52
Q

Mx of macrolide?

A

Mycoplasma pneumonia - treat with doxycycline or a macrolide

53
Q

What is the most effective single step to reduce the incidence of MRSA?

A

Hand hygiene

54
Q

Most important ix to exclude HIV seroconversion?

A

p24 antigen test

55
Q

Severe joint pain + high fever after returning from Africa / asia / indian subcontinent?

A

Chikungunya

56
Q

How must live vaccines be given? (time period in between)

A

Live vaccines given by injection may be either given concomitantly or a minimum interval of 4 weeks apart to prevent risk of immunological interference

57
Q

Mx of pubic lice?

A

application of either: malathion 0.5%, permethrin 1%, phenothrin 0.2% or carbaryl 0.5%

All of these creams or lotions are applied to all body hair and left on the hair for the recommended ‘treatment time’ before being washed off.

Treatment should be re-applied after 3-7 days: this is due to the presence of lice and eggs being at different stages of their life cycle.

Re-examination 1 week after this

58
Q

Which organism can present with culture -ve endocarditis? mx?

A

Coxiella burnetti

Mx - doxycycline

59
Q

What is non-specific (non-gonococal) urethritis? mx?

A

common presentation where inflammatory cells but no gonococcal bacteria are seen on swab

Tx - Doxycycline / Azithromycin

60
Q

Triad of disseminated gonoccal infection?

A

Tenosynovitis

Migratory polyarthritis

Dermatitis

61
Q

MoA of botulinim toxin?

A

Botulinum toxin inhibits the release of acetylcholine at synapses

62
Q

What are the features of typhus?

Mx?

A

fever, headache, malaise
rash
- typically maculopapular
- begins on the trunk and spreads to the extremities
later complications
- meningoencephalitis

Mx: Doxycycline

63
Q

Which infection typically presents as: flu like illness → brief remission→ followed by jaundice and haematemesis

A

Yellow fever

64
Q

Which species of malaria has shortest replication cycle - what does this mean in practice?

A

P. knowlesi has the shortest erythrocytic replication cycle, leading to high parasite counts in short periods of time

65
Q

Normal causes of genital ulcers, painful and painless

A

painful: herpes much more common than chancroid

painless: syphilis more common than lymphogranuloma venereum (painful lymphadenopathy less likely in latter)

66
Q

HIV drugs and their MOAs?

A

NRTIs end in ‘ine’ (Nucleoside analogue reverse transcriptase inhibitors)

PIs: end in ‘vir’ (Protease inhibitor)

NNRTIs: nevirapine, efavirenz (Non-nucleoside reverse transcriptase inhibitors)

67
Q

Common complications of PCP pneumonia?

A

Pneumothorax

68
Q

Aciclovir MoA?

A

DNA polymerase inhibitor

69
Q

Patients with hyposplenism should be vaccinated against which disease?

A

pneumococcal, Haemophilus type B and meningococcus type B+C

70
Q

Infection following renal transplant is most commonly caused by?

A

CMV

71
Q

What is the typical signs of infection with mycobacterium marinum?

A

Fish tank granuloma - 3-4w incubation and leisons can be painful or painless

If there is a skin break can lead to systemic spread (sporotrichoid spread)

Tx can include- Tetracyclines, fluoroquinolones, sulfonamides and macrolides

72
Q

Can you breast feed with HIV?

A

No regardless of viral count

73
Q

Neonatal ART in HIV?

A

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.

74
Q

Delivery of babies in mothers with HIV?

A

vaginal delivery is recommended if viral load is less than 50 copies/ml at 36 weeks, otherwise caesarian section is recommended

a zidovudine infusion should be started four hours before beginning the caesarean section

75
Q

What is thick and thin blood films used for?

A

Thick blood films check for parasite burden

Thin films allow for speciation

76
Q

Severe hepatitis in a pregnant woman

What organism?

A

Hep E

77
Q

Fever and the presence of a eschar in a patient returning from South East Asia is strongly suggestive of

What infection and tx?

A

scrub typhus (caused by Orientia tsutsugamushi) and necessitates urgent treatment with doxycycline

78
Q

Relative CI for donepezil ?

A

Bradycardia eg sick sinus syndrome

79
Q

Can you use memantine in mild dementia?

A

No reserved as 2nd live tx and at least moderate

80
Q

What are some RFs for pressure ulcers?

A

malnourishment
incontinence: urinary and faecal
lack of mobility
pain (leads to a reduction in mobility)

81
Q

Schistosoma haematobium is most strongly associated with what ca?

A

Schistosomiasis is a risk factor for

Squamous cell bladder cancer

82
Q

For non-falciparum malaria: mx?

A

For non-falciparum malaria:
in areas which are known to be chloroquine-sensitive then WHO recommend either an artemisinin-based combination therapy (ACT) or chloroquine

in areas which are known to be chloroquine-resistant an ACT should be

83
Q

If a sexually active patient presents with genital chlamydia and bowel symptoms

What should be considered? tx?

A

LGV proctocolitis - presents with tenesmus, rectal bleeding, and discharge. LGV is particularly prevalent among men who have sex with men and requires targeted treatment, typically with a prolonged course of doxycycline.

84
Q

Mx of genital warts?

A

multiple, non-keratinised warts: topical podophyllum (imiquimod is a topical cream - used 2nd line)

solitary, keratinised warts: cryotherapy

85
Q

Mx of Severe falciparum malaria?

A

intravenous artesunate

if parasite count > 10% then exchange transfusion should be considered

shock may indicate coexistent bacterial septicaemia - malaria rarely causes haemodynamic collapse

(Parasite count >2% usually needs paraenteral tx regardless of clinical picture)

86
Q

Most common complication of Gonorrhoea infection?

A

Infertility secondary to PID

87
Q

Most common causes of PID?

A
  1. Chlamydia
  2. Gonorrhoea
88
Q

When should vaccination occur for splenectomy and what about abx prophylaxis

A

if elective, should be done 2 weeks prior to operation

Pen V prophylaxis - at least 2 years and until they’re 16 but often lifelong

89
Q

What should be provided in non-falciparum malaria after acute mx + why?

A

Primaquine - destroys liver hypnozoites + prevents relapse

90
Q

When should asuymptomatic bacteriuria be treated?

A

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

91
Q

Which organisms cause endemic and epidemic typhus

A

Rickettsia typhi is the organism causing endemic typhus.

Rickettsia prowazekii is the organism causing epidemic typhus.

92
Q

What is the first step in suspected Lyme disease without erythema migrans?

A

ELISA test

93
Q

What ix is used to identify fungi in tissue samples eg PCP?

A

silver stain

94
Q

Mx of Chagas disease (Trypanosoma cruzi)

A

treatment is most effective in the acute phase using azole or nitroderivatives such as benznidazole or nifurtimox

95
Q

Non-bloody diarrhoea, bloating, weight loss +- malbsorption / lactose intolerance

Which organism + mx?

A

Giardasis - giardia lamblia

Tx - metronidazole

96
Q

Cutaneous larva migrans (CLM)

mx?

A

Thiabendazole

97
Q

Gram-positive rod (bacilli) causing meningitis?

A

Listeria monocytogenes

98
Q

Cutaneous leishmaniasis requires treatment when?

A

cutaneous leishmaniasis acquired in South or Central America merits treatment due to the risk of mucocutaneous leishmaniasis whereas disease acquired in Africa or India can be managed more conservatively

99
Q

Shigella mx?

A

Usually supportive but:

antibiotics (e.g. ciprofloxacin) are indicated for people with severe disease, who are immunocompromised or with bloody diarrhoea

100
Q

What are the main complications of chronic chagas?

A

myocarditis (biggest cause of mortality) may lead to dilated cardiomyopathy (with apical atophy) and arrhythmias

gastrointestinal features includes megaoesophagus and megacolon causing dysphagia and constipation

101
Q

most common bacterial cause of pharyngitis (sore throat) in children and young adults is what?

A

Strep pyogenes

102
Q

Opisthotonus - what is this and when is it seen?

A

state of a hyperextension and spasticity in which a patient’s neck and spinal column enter into an arching position

Seen in tetanus due to spasm of axial muscles

103
Q

Tetans mx:

A

Patient has had a full course of tetanus vaccines (5), 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

104
Q

mx of different levels of anti-HBs (Hep B)

A

> 100 Indicates adequate response, no further testing required. Should still receive booster at 5 years

10 - 100 Suboptimal response - one additional vaccine dose should be given. If immunocompetent no further testing is required

< 10 Non-responder. Test for current or past infection. Give further vaccine course (i.e. 3 doses again) with testing following. If still fails to respond then HBIG would be required for protection if exposed to the virus

105
Q

How to distinguish between different types of inguinal lymphadenopathy and genital ulcer

A

Inguinal Lymphadenopathy is present in Syphilis, LGV and Chancroid

1. Painless IL + Painless ulcer - Syphilis

2. Painful IL + Painless ulcer - LGV

3. Painful IL + Painful ulcer - Chancroid

ChanCRIED in pain
SyphiLESS (painless)
LGV mix (starts with lymph so this is the painful bit)

106
Q

Why can TB lead to low Na, raised K and hypotension?

A

M. tuberculosis can cause hypoadrenalism

  • check serum cortisol
107
Q

Which vaccines to avoid with egg allergy

A

●● Influenza
●● Tick-borne encephalitis
●● Yellow fever
●● Hepatitis A

108
Q

What type of reaction is caused by tuberculin skin tests? What is this mediated by?

A

Type IV hypersensitivity (delayed)

Mediated by inteferon gamma by th1 cells -> macrophage activation

109
Q

How is amoebic dysentery investigated?

A

stool microscopy may show trophozoites if examined within 15 minutes or kept warm (known as a ‘hot stool’)

110
Q

Mx of amoebic dysentry?

A

Oral metronidazole

a ‘luminal agent’ (to eliminate intraluminal cysts) is recommended usually as well e.g. diloxanide furoate

111
Q

What is immune reconstitution inflammatory syndrome?

A

Condition associated w HIV / immunosuppression

Occurs when the immune system begins to recover, but then responds to a previously acquired opportunistic infection with an overwhelming inflammatory response that paradoxically makes the symptoms of infection worse.

112
Q

Mantoux test interpretation?

A

Diameter of induration

< 6mm = Negative - no significant hypersensitivity to tuberculin protein Previously unvaccinated individuals may be given the BCG

6 - 15mm = Positive - hypersensitive to tuberculin protein, Should not be given BCG. May be due to previous TB infection or BCG

> 15mm = Strongly positive - strongly hypersensitive to tuberculin protein Suggests tuberculosis infection.

113
Q

Causes of false -ve mantoux test?

A

miliary TB
sarcoidosis
HIV
lymphoma
very young age (e.g. < 6 months)

114
Q

ART suffix gravir - what is the mechanism?

A

Integrase inhibitors (‘gravirs’) - blocks the enzyme that inserts the viral genome into the DNA of the host cell

115
Q

ART suffix ‘navir’ MoA? which one is a potent inhibitor of P450 system?

A

Protease inhibitors (PI)

Ritonavir - potent inhibtor of P450

116
Q

nevirapine, efavirenz

are examples of what type of medication?

A

ART - Non-nucleoside reverse transcriptase inhibitors

117
Q

zidovudine (AZT), abacavir, emtricitabine, didanosine, lamivudine, stavudine, zalcitabine, tenofovir

Are all examples of what class of ART? general side effect associated?

A

Nucleoside analogue reverse transcriptase inhibitors (NRTI)

Generally associated with peripheral neuropathy

118
Q

Mx of meningeal tb?

A

RIPE for prolonged period (at least 12 months)

+ Steroids

119
Q

TV v BV discharge colour

A

BV - grey white

TV - green frothy

120
Q

What is filariasis commonly caused by? what does this cause?

A

W. Bancrofti

Leads to lymphatic obstruction
usually diagnosed w blood smear

tx = diethycarbamazine

121
Q

Is there a Hep C vaccine and can you treat it?

A

No vaccine but treatment is successful in majority

122
Q

Mx of campylobacter gastroenteritis in immunocompromised patients?

A

Supportive + clarithromycin (cipro also possible but frequently)

123
Q

Describe what is Monod sign and what is it suggestive of?

A

a mass within a cavity with a ‘Monod sign’ (the crescent of the surrounding air)

Suggestive of aspergiloma

124
Q

Possible complications of diptheria?

A

neuritis e.g. cranial nerves

heart block

125
Q

Signs of severe campylobacter that warrants abx therapy?

A

Immunocompromised pt

High fever

Bloody diarrhoea

8+ stools /day

MRCP - Passmed (17 decks)

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