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Focused Xtra > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

What is the treatment of choice for gonorrhoea?

A

Intramuscular ceftriaxone

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2
Q

How do we cover for animal or human bites?

A

Co-amox

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3
Q

How do we treat bacterial vaginosis?

A

Metronidazole 400mg BD for 7/7

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4
Q

A 30-year-old who is currently 27 weeks pregnant comes to see you about a thin, white discharge. Swabs are taken and clue cells are seen on microscopy. Dx?

A

Bacterial vaginosis

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5
Q

What is a disulfiram-like reaction?

A

The combination of metronidazole and ethanol can cause a disulfiram-like reaction. Clinical features of this include head and neck flushing, nausea and vomiting, sweatiness, headache and palpitations.

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6
Q

Which bacteria is often seen in under-re-heated rice?

A

Bacillus cereus

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7
Q

Which type of vaccine are contraindicated in HIV positive patients?

A

Live attenuated, e.g. TB, Yellow fever
Oral polio
Intranasal influenza
Varicella
Measles, mumps and rubella (MMR)

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8
Q

How do we treat trichomonas vaginalis?

A

oral metronidazole

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9
Q

What is trichomonas vaginalis?

A

Trichomonas vaginalis is a protozoan parasite that causes trichomoniasis, a sexually transmitted infection. Metronidazole is an antiprotozoal medication used to treat infections caused by protozoa such as Trichomonas vaginalis. It works by inhibiting nucleic acid synthesis by disrupting the DNA of microbial cells. In the UK, according to BASHH guidelines, oral metronidazole 2g single dose or 400mg twice daily for 5-7 days are recommended first-line treatments for trichomoniasis.

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10
Q

A 30-year-old woman is admitted with pneumonia to hospital. She has a fever and a dry cough. On examination erythema multiforme is noted and bloods show she has a normocytic anaemia. What is the most likely causative organism?

A

Mycoplasma pneumoniae causes haemolysis

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11
Q

How do we treat genital herpes?

A

Oral aciclovir

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12
Q

How does legionella affect U&Es?

A

Hyponatraemia - inappropriate secretion of antidiuretic hormone secondary to bacterial pneumonia, Vasopressin decreases water excretion by the kidneys. As a result, more water is retained in the body, which dilutes the level of sodium in the body.

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13
Q

What is the most common cause of cold sores?

A

Herpes simplex virus type 1.

Type 2 often causes genital herpes

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14
Q

Where do you see rose spots on the abdomen?

A

Salmonella typhi infection can cause rose spots on the abdomen

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15
Q

How do we test for Lyme disease?

A

ELISA (blood test for serology) is the first-line investigation for suspected Lyme disease in patients with no history of erythema migrans

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16
Q

Which organism causes syphilis?

A

Treponema pallidum

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17
Q

How does syphilis present?

A

The first stage typically involves a painless genital ulcer (chancre), as reported by the patient two months ago. The second stage, which can occur weeks to months after the initial infection, is characterised by a widespread maculopapular rash and mucosal lesions such as mouth ulcers.

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18
Q

How do we treat pneumocystis jiroveci pneumonia?

A

Pneumocystis jiroveci penumonia is treated with co-trimoxazole, which is a mix of trimethoprim and sulfamethoxazole

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19
Q

What causes infectious mononucleosis?

A

Infectious mononucleosis (glandular fever) is caused by the Epstein-Barr virus (EBV, also known as human herpesvirus 4, HHV-4) in 90% of cases. Less frequent causes include cytomegalovirus and HHV-6. It is most common in adolescents and young adults.

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20
Q

How does mono present?

A

The classic triad of sore throat, pyrexia and lymphadenopathy is seen in around 98% of patients:
sore throat
lymphadenopathy: may be present in the anterior and posterior triangles of the neck, in contrast to tonsillitis which typically only results in the upper anterior cervical chain being enlarged
pyrexia

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21
Q

Which rash can sometimes be seen in infectious mononucleosis?

A

A maculopapular, pruritic rash develops in around 99% of patients who take ampicillin/amoxicillin whilst they have infectious mononucleosis

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22
Q

How do we diagnose mono?

A

Monospot test

heterophil antibody test (Monospot test)
NICE guidelines suggest FBC and Monospot in the 2nd week of the illness to confirm a diagnosis of glandular fever.

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23
Q

How do we manage mono?

A

Management is supportive and includes:
rest during the early stages, drink plenty of fluid, avoid alcohol
simple analgesia for any aches or pains
consensus guidance in the UK is to avoid playing contact sports for 4 weeks after having glandular fever to reduce the risk of splenic rupture

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24
Q

The parents of a 19-year-old man have just been messaged by their son who is currently backpacking in Thailand. Earlier in the day he was bitten by a dog whilst staying in a rural community. Prior to travelling, he received vaccination against rabies as he was going to be visiting many rural areas. What is the most appropriate advice?

A

He should urgently seek local medical attention, for the consideration of abx and further booster vaccination

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25
Q

What is the main side effect to be aware of for ethambutol?

A

E for eyes (optic neuritis)

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26
Q

What can pyrazinamide cause?

A

Gout

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27
Q

What is the main side effect to be aware of for isoniazid?

A

IsoNERVEzid - peripheral neuropathy

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28
Q

How do we treat positive syphilis in pregnancy?

A

IM benzathine penicillin G

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29
Q

What is Kaposi’s sarcoma?

A

Kaposi’s sarcoma
caused by HHV-8 (human herpes virus 8)
presents as purple papules or plaques on the skin or mucosa (e.g. gastrointestinal and respiratory tract)
skin lesions may later ulcerate
respiratory involvement may cause massive haemoptysis and pleural effusion

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30
Q

How do we treat Kaposi’s sarcoma?

A

radiotherapy + resection

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31
Q

How would cryptococcus neoformans present on LP?

A

cryptococcus neoformans stains well with india ink allowing it to be detected on a lumbar puncture

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32
Q

How does mycoplasma pneumoniae present?

A

Stereotypical history of mycoplasma pneumonia: worsening flu-like symptoms and a dry cough. Erythema multiforme is noted on examination

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33
Q

Should you treat asymptomatic bacteria in catheterised patients?

A

No

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34
Q

Where do you see strawberry cervix?

A

Trichomonas

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35
Q

What are Amsel’s criteria for BV?

A

Amsel’s criteria for diagnosis of BV - 3 of the following 4 points should be present
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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36
Q

What causes disulfiram-like reaction?

A

These effects are caused by accumulation of acetaldehyde, a major but toxic metabolite of alcohol formed by the enzyme alcohol dehydrogenase

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37
Q

Which antibiotic do we use to treat MRSA infections?

A

Vancomycin

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38
Q

What do we give for prophylaxis for contacts of patients with meningococcal meningitis?

A

Oral ciprofloxacin or rifampicin is used as prophylaxis for contacts of patients with meningococcal meningitis

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39
Q

Which abx do we give for pelvic inflammatory disease?

A

Doxycycline + metronidazole + ceftriaxone

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40
Q

What is diptheria?

A

Diphtheria is a bacterial infection caused by Corynebacterium diphtheriae which primarily infects the throat and upper airways, leading to difficulty in breathing and swallowing. A grey coating surrounding the tonsils, fever, and cervical lymphadenopathy are classic symptoms of this disease. The patient’s recent travel from India also suggests diphtheria as it is more common in countries with less access to immunisation.

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41
Q

What is dengue fever?

A

Dengue fever is a viral illness transmitted by mosquitoes that commonly causes high fever, severe headache, pain behind the eyes, joint pain, muscle and bone pain, rash, and mild bleeding.H

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42
Q

How does typhoid fever present?

A

Typhoid and Paratyphoid fevers present with prolonged high-grade fever associated with relative bradycardia, malaise, headache, cough

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43
Q

Which abx should be avoided when taking methotrexate?

A

This patient should not be given trimethoprim/co-trimoxazole concurrently with methotrexate due to the risk of bone marrow aplasia. As methotrexate and trimethoprim are both anti-folate medications, the additive folate depletion when combined can lead to pancytopenia, megaloblastic anaemia, and bone marrow suppression.

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44
Q

Where do you see erythema migrans?

A

Erythema migrans is a red non-itchy rash that is classically associated with Lyme disease and develops a bulls eye appearance as it increases in size

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45
Q

How do we treat campylobacter?

A

Clari

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46
Q

What causes genital warts in most cases?

A

90% are caused by HPV 6 & 11

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47
Q

Which HPV strains are associated with cervical cancer?

A

I remember HPV 16 and 18 for cervical cancer

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48
Q

What does a single, painful genital ulcer generally indicate?

A

Chancroid

Caused by Haemophilus ducreyi

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49
Q

What does multiple, painless genital ulcers generally indicate?

A

HPV warts

50
Q

What does multiple, painful genital ulcers generally indicate?

A

Herpes simplex

51
Q

How do we manage parvovirus exposure in pregnancy?

A

IgG positive & IgM negative - shows immunity to parvovirus. Reassure, no further action.

IgG negative & IgM positive - non-immune. Recent parvovirus infection in last 4 weeks. Refer immediately for further tests/fetal medicine.

52
Q

How do we manage genital herpes in pregnancy?

A

women who present with first-episode genital herpes during their third trimester should be managed with daily suppressive oral aciclovir 400mg until delivery. Delivery should be by caesarean section due to a high risk of neonatal HSV (herpes simplex virus) transmission.

53
Q

How do we investigate Lyme disease?

A

NICE recommend that Lyme disease can be diagnosed clinically if erythema migrans is present
erythema migrans is therefore an indication to start antibiotics
enzyme-linked immunosorbent assay (ELISA) antibodies to Borrelia burgdorferi are the first-line test
if negative and Lyme disease is still suspected in people tested within 4 weeks from symptom onset, repeat the ELISA 4-6 weeks after the first ELISA test. If still suspected in people who have had symptoms for 12 weeks or more then an immunoblot test should be done
if positive or equivocal then an immunoblot test for Lyme disease should be done

54
Q

How do we manage asymptomatic tick bite?

A

Reassure

55
Q

How do we treat Lyme disease in pregnancy?

A

Amoxi

14-21 day course doxy if not preggers

56
Q

Which organism causes BV?

A

Gardnerella vaginalis

57
Q

What is the most common causative organism of pneumonia in a smoker?

A

Strep pneumoniae

58
Q

Which vaccines are live attenuated?

A

MY BOOTII = Mmr, Yellow fever, Bcg, Oral polio, Oral rotavirus, Typhoid, Intranasal influenza

59
Q

What is leptospirosis?

A

Generally unwell with subconjunctival haemorrhages

Leptospirosis is caused by the spirochaete Leptospira interrogans (serogroup L. icterohaemorrhagiae), classically being spread by contact with infected rat urine.

Epidemiology
leptospirosis is commonly seen in questions referring to sewage workers, farmers, vets or people who work in an abattoir
however, on an international level, leptospirosis is far more common in the tropics so should be considered in the returning traveller

60
Q

How do we treat leptospirosis?

A

high-dose benzylpenicillin or doxycycline

61
Q

How do we manage MRSA +ve skin prior to surgery?

A

Nasal mupirocin + chlorhexidine for the skin

Mupirocin is a topical antibiotic that eradicates MRSA from the anterior nares, which is its most common colonisation site. Chlorhexidine is an antiseptic that reduces MRSA on the skin.

62
Q

When must HIV post-exposure prophylaxis be given?

A

By 72 hours after event

63
Q

What is the first-line tx for prostatitis?

A

Cipro

64
Q

What is gas gangrene?

A

Gas gangrene is a life-threatening bacterial infection with gangrene that can cause muscle necrosis, sepsis, gas production and ultimately, death.

65
Q

Which organism is usually causative of gas gangrene?

A

Clostridium perfringens.

Can be found in soil.

66
Q

Which diseases are notifiable?

A

Those with vaccines

67
Q

How do we treat legionella

A

Clari (macrolide)

68
Q

What is erythema infectiosum, and what causes it?

A

Erythema infectiosum (also known as fifth disease or ‘slapped-cheek syndrome’)

Caused by parvovirus B19

69
Q

What is Fitz-Hugh-Curtis syndrome?

A

Fitz-Hugh-Curtis syndrome is a complication of pelvic inflammatory disease in which the liver capsule becomes inflamed causing right upper quadrant pain. This leads to scar tissue formation and peri-hepatic adhesions. It usually occurs in women who have either chlamydia or gonorrhoea.

70
Q

What is the most common cause of traveller’s diarrhoea?

A

E. coli

71
Q

What most likely causes pneumonia in an alcoholic

A

Klebsiella

72
Q

How does Behcet’s disease present?

A

The classic triad in Behcet’s is oral ulcers, genital ulcers and uveitis. Venous thromboembolism is also seen.

73
Q

Which malignancies is EBV associated with?

A

Burkitt’s lymphoma
Hodgkin’s lymphoma
nasopharyngeal carcinoma

74
Q

How do we treat genital wartS?

A

Genital wart treatment
multiple, non-keratinised warts: topical podophyllum
solitary, keratinised warts: cryotherapy

75
Q

How do we manage tetanus prone wounds in a pt with unknown tetanus vaccination hx?

A

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

76
Q

What causes Kaposi’s sarcoma?

A

caused by HHV-8 (human herpes virus 8)

Kaposi’s has 8 characters in total including the apostrophe. Therefore, it’s HHV-8.

77
Q

What is the most commonly affected site with necrotising fasciitis?

A

Necrotising fasciitis: most commonly affected site is the perineum

78
Q

What is giardiasis caused by?

A

Giardiasis, caused by the parasite Giardia lamblia, has the longest incubation period among the given options. The incubation period for Giardiasis typically ranges from 1 to 2 weeks, but it can extend up to 6 weeks in some cases.

79
Q

A 29-year-old woman develops severe vomiting four hours after having lunch at a local restaurant. What is the most likely causative organism?

A

S aureus

80
Q

What causes the common cold

A

RhinovirusWh

81
Q

What causes the flu

A

Influenza

82
Q

A 25-year-old man presents to the clinic with urethral discharge and dysuria for the past two days. He is investigated for the cause of his symptoms, and a nucleic acid amplification test (NAAT) for Chlamydia trachomatis is positive. During the consultation, he enquires about whether he needs to inform his sexual partners.

What is the appropriate guidance based on his diagnosis?

A

Chlamydia - partner notification:
symptomatic men: all partners from the 4 weeks prior to the onset of symptoms
women + asymptomatic men: all partners from the last 6 months or the most recent sexual partner

83
Q

How does hepatitis A present?

A

The patient has flu-like symptoms, right upper quadrant pain, tender hepatomegaly, and jaundice after recent travel to Thailand, a region with a higher prevalence of hepatitis A.

84
Q

How does hepatitis C present?

A

Hepatitis C, in the acute stage, is typically more insidious and often presents without jaundice or other symptoms. Furthermore, it is primarily transmitted via blood.

85
Q

How is hep A transmitted?

A

transmitted via the faecal-oral route (in keeping with his history of drinking tap water while travelling)

86
Q

How do we treat hep A?

A

Hepatitis A typically has a self-limiting course, and most people recover completely within weeks to months without any long-term effects on the liver.

87
Q

A 25-year-old immunocompetent woman presents to her GP with a two-week history of low-grade fever, fatigue, and cervical lymphadenopathy. She recently adopted a cat and has been regularly cleaning its litter box. She feels generally unwell but has no eye pain, vision changes, or neurological symptoms. Serology tests confirm a Toxoplasma gondii infection.

Tx?

A

Toxoplasmosis

Monitor - no need to start tx in immunocompetent pt

88
Q

A 24-year-old man presents to the emergency department after sustaining a deep laceration to his forearm while working in his garden. He reports receiving his last tetanus vaccine six years ago and has had a total of five doses in his lifetime. The laceration is approximately 4 cm deep and bleeding moderately.

What is the most appropriate management regarding tetanus prophylaxis?

A

If a patient has had 5 doses of tetanus vaccine, with the last dose < 10 years ago, they don’t require a booster vaccine nor immunoglobulins, regardless of how severe the wound is

89
Q

A 24-year-old woman is brought to the emergency department by her partner after experiencing a severe headache, neck stiffness, and photophobia for the past 12 hours. On examination, her heart rate is 110 bpm, her blood pressure is 145/90 mmHg, and her temperature is 38.9 °C. Fundoscopy reveals papilloedema. Neurological examination shows no focal deficits. Her GCS is 14/15.

Which is the most appropriate next step in management?

A

Administer intravenous ceftriaxone and dexamethasone only - no need for LP if signs of ICP

90
Q

How do we treat chlamydia in pregnant women?

A

Doxycycline is incorrect. This is first-line in non-pregnant patients, however, this patient is pregnant, making tetracyclines (including doxycycline) contraindicated as they are teratogens and can affect tooth and bone development in babies.

Azithromycin, erythromycin or amoxicillin may be used to treat Chlamydia in pregnancy

91
Q

A 24-year-old patient presents to the GP clinic requesting a sexual health check. He has sex with men and participates in condomless anal intercourse both insertive and receptive. He has not had any HIV tests previously and would like a result as soon as possible.

What test would be the most appropriate to order for this patient?

A

Combination tests (HIV p24 antigen and HIV antibody) are now standard for the diagnosis and screening of HIV

92
Q

How do we manage latent TB?

A

Latent tuberculosis treatment options:
3 months of isoniazid (with pyridoxine) and rifampicin, or
6 months of isoniazid (with pyridoxine)

93
Q

What is the Post-exposure prophylaxis for HIV?

A

Post-exposure prophylaxis for HIV: oral antiretroviral therapy for 4 weeks

94
Q

Where do you see positive Anti-HCV?

A

Hep C infection

95
Q

How does campylobacter infection present?

A

Campylobacter infection is characterised by a prodrome, abdominal pain and bloody diarrhoea - onsent 1-6 days

Salmonella has a more acute onset within 12-48hrs

96
Q

How does haemolytic uraemic syndrome present?

A

Haemolytic anaemia, renal failure, low platelets

Differs to HELPP syndrome with elevated liver enzymes, not renal failure

97
Q

What causes HUS?

A

It is usually caused by Escherichia coli subtype 0157. Treatment is supportive as antibiotics are contraindicated.

98
Q

How many doses of tetanus vaccine generally confers life-long protection?

A

5

99
Q

How does gardnerella vaginalis present on Gram staining?

A

gram variable staining organism

100
Q

How does S aureus pneumonia present?

A

This patient has symptoms of influenza (dry cough, myalgia and fever) leading to complicating Staphylococcus aureus pneumonia. Her presentation with blood-streaked (or rusty) sputum, pleuritic chest pain, and x-ray findings of thin walled cavitating lesion w/ associated pleural effusion

101
Q

What can predispose you to S aureus pneumonia?

A

Recent influenza infection

102
Q

What is the most common cause of CAP?

A

Strep pneumoniae

103
Q

When can we not give nitro in pregnancy?

A

Third term

104
Q

A 30-year-old woman who is 38 weeks pregnant presents with dysuria and urinary frequency. A urine dipstick is positive for nitrites and leucocytes. Mx?

A

Cefalexin

105
Q

What is the incubation period of B cereus?

A

This bacterium causes a type of food poisoning that can result in diarrhoea within 6-15 hours after ingestion of contaminated food, making it the pathogen with the shortest incubation period on this list

106
Q

How does erysipelas present?

A

A 62-year-old woman attends the emergency department with an erythematous skin lesion 6cm in diameter on her upper arm following a high fever of 39ºC, a headache and some vomiting over the past 48 hours. A skin biopsy showed a beta-haemolytic group A streptococcal infection in the upper dermis.

107
Q

What normally causes eryspielas?

A

S pyogenes

108
Q

A 17-year-old man attends the local sexual health clinic. He has developed a large, keratinised genital wart on the shaft of his penis. This has been present for around three months but he has been too embarrassed to present before now. What is the most appropriate initial management?

A

Cryotherapy

109
Q

Which antibiotic is associated with photosensitivity?

A

Doxy

110
Q

Which anti-malarial cannot be given with co-inciding depressipon?

A

Mefloquine - taken weekly

Contraindicated in epilepsy

111
Q

How do we treat cellulitis in pregnancy?

A

Erythromycin is the antibiotic of choice for cellulitis in pregnancy if the patient is penicillin allergic

Oral flucloxacillin as first-line treatment for mild/moderate cellulitis otehrwise

112
Q

How do we treat invasive diarrhoea (causing bloody stools and fever), such as salmonella?

A

Cipro

Salmonella = S(c)iprofloxacin
Campylobacter = Clamp-rithromycin

113
Q

How do we treat Lyme disease?

A

14-21 day course doxycycline

114
Q

Who is offered the HPV vaccine?

A

All boys aged 12-13 (school year 8) are now offered the HPV vaccine as well as girls

115
Q

How do we treat severe campylobacter

A

there are always mice (ClarithroMYCin) at the camp (CAMPylobacter)

116
Q

How does typhoid fever present?

A

Rose spots + constipation

117
Q

How do we treat erysipelas?

A

Fluclox

118
Q

How do we treat dental abscess?

A

Amox

119
Q

How do we treat BV with penicillin allergy

A

Would be oral metro, now topical clinda

120
Q

How does S aureus gastroenteritis present?

A

Staphylococcus aureus gastroenteritis is characterised by a short incubation period and severe vomiting

121
Q
A

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