Infectious Disease Flashcards
1
Q
Antibiotic for animal bites
A
Co-amox
Doxy and metronidazole if pen allergic
2
Q
Antibiotic for human bites
A
Co-amox
3
Q
Antibiotic for exacerbations of chronic bronchitis
A
Amox, tetracycline, or clarithromycin
4
Q
Antibiotic for uncomplicated CAP
A
Amox
Doxy or clarithro in pen allergic, add fluclox if staph suspected e.g. in influenza
5
Q
Antibiotic for ?atypical pneumonia
A
Clarithromycin
6
Q
Antibiotic for HAP
A
If within 5 days of admission - co-amox or cefuroxime
If more than 5 days after admission - taz or broad spectrum ceph, e.g. ceftazidime, or quinolone e.g. cipro
7
Q
Antibiotic UTI
A
Trimethoprim or nitro
Alternative: amox or cephalosporin
8
Q
Antibiotic acute pyelonephritis
A
Broad spectrum cephalosporin or quinolone
9
Q
Antibiotic acute prostatitis
A
Quinolone or trimethoprim
10
Q
Antibiotic impetigo
A
Topical hydrogen peroxide
Oral fluclox or erythromycin if widespread
11
Q
Antibiotic cellulitis
A
Fluclox
Clarithromycin, erythromycin, or doxycycline if pen allergic
12
Q
Antibiotic cellulitis near the eyes or nose
A
Co-amox
Clarithromycin and metronidazole if pen allergic
13
Q
Antibiotic erysipelas
A
Fluclox
Clarithromycin, erythromycin, or doxy if pen allergic
14
Q
Antibiotics mastitis
A
Fluclox
15
Q
Antibiotics throat infections
A
Phenoxymethylpenicillin
Erythromycin if pen allergic
16
Q
Antibiotic sinusitis
A
Phenoxymethylpenicillin
17
Q
Antibiotic otitis media
A
Amoxicillin
Erythromycin if pen allergic
18
Q
Antibiotics otitis externa
A
Fluclox
Erythromycin if pen allergic
19
Q
Antibiotics periapical or periodontal abscess
A
Amox
20
Q
Antibiotics acute necrotising ulcerative gingivitis
A
Metronidazole
21
Q
Antibiotics gonorrhoea
A
IM ceftriaxone
22
Q
Antibiotics Chlamydia
A
Doxycycline or azithromycin
23
Q
Antibiotics pelvic inflammatory disease
A
Oral ofloxacin and oral metronidazole
or
IM ceftriaxone and oral doxy and oral metronidazole
24
Q
Antibiotics syphilis
A
Benzathine benzylpenicillin
or
Doxycycline and erythromycin
25
Antibiotics bacterial vaginosis
Oral or topical metronidazole
or
Topical clindamycinA
26
Antibiotics C. diff
First episode: oral vancomycin
Second/subsequent episode: oral fidaxomicin
27
Antibiotics campylobacter enteritis
Clarithromycin
28
Antibiotics salmonella (non-typhoid)
Ciprofloxacin
29
Antibiotics shigellosis
Ciprofloxacin
30
Adverse effects aminoglycosides
- Nephrotoxicity
- Ototoxicity
31
Adverse effects tetracyclines
- Discolouration of teeth
- Photosensitivity
32
Adverse effects chloramphenicol
Aplasia anaemia
33
Adverse effects clindamycin
C. Diff
34
Adverse effects macrolides
Nausea (esp erythromycin)
P450 inhibitor
Prolonged QT
35
Adverse effects azoles
P450 inhibition
Liver toxicity
36
Adverse effects amphotericin B
Nephrotoxicity
Flu like symptoms
Hypokalaemia
Hypomagnasaemia
37
Adverse effects griseofulvin
Induces P450 system
Teratogenic
38
Adverse effects flucytosine
Vomiting
39
Adverse effects caspofungin
Flushing
40
Contraindications BCG vaccine
- Previous BCG vaccine
- Past history TB
- HIV
- Pregnancy
- Positive tuberculin test
- Over 35 (no evidence it works)
41
Most common bacterial cause of infectious intestinal disease in UK
Campylobacter
42
Features of campylobacter
Prodrome of headache and malaise
Often bloody diarrhoea
Abdo pain
43
Most common protozoal cause of diarrhoea in UK
Cryptosporidiosis
44
Features of cryptosporidial diarrhoea
- More common in immunocompromised and young children
- Watery diarrhoea
- Abdominal cramps
- Fever
45
Complication of cryptosporidial diarrhoea in immunocompromised
Entire GI tract may be affected resulting in sclerosing cholangitis and pancreatitis
46
Management of cryptosporidial diarrhoea -
- Supportive if immunocompetent
- Nitazoxanide or rifaximin for immunocompromised
47
Features of diptheria
Diptheric membrane on tonsils - grey, pseudomembrane on posterior pharyngeal wall
Bulky cervical lymphadenopathy
Neuritis, e.g. cranial nerve
Heart blocka
48
Management of diptheria
IM penicillin
Diptheria antitoxin
49
Features of enteric fever (typhoid/paratyphoid)
- Systemic features - fever, headache, arthralgia
- Relative bradycardia
- Abdominal pain and distention
- Constipation
- Rose spots (more common in paratyphoid)
50
Complications of enteric fever
Osteomyelitis
GI bleed/perforation
Meningitis
Cholecystitis
Chronic carriage
51
Most common cause of travellers diarrhoea
E coli
52
Most common causes of acute food poisioning
- Staphylococcus aureus
- Bacillus cereus
- Clostridium perfringens
53
Features of E coli gastroenteritis
Watery stools
Abdominal cramps and nauseaF
54
Features of giardiasis gastroenteritis
Prolonged, non-bloody diarrhoea
Foul smelling burps
Bloating
Steatorrhoea
Malabsorption and lactose intolerance
55
Features of cholera gastroenteritis
Profuse, watery diarrhoea
Severe dehydration resulting in weight loss
Not common in travellers
56
Features of shigella gastroenteritis
Bloody diarrhoea
Vomiting and abdominal pain
57
Features of S aureus gastroenteritis
Severe vomiting
Short incubation period
58
Features of campylobacter gastroenteritis
Flu-like prodrome usually followed by crampy abdominal pain, fever, and diarrhoea which may be bloody
Can mimic appendicitis
59
Features of bacillus cereus gastroenteritis
Vomiting within 6 hours
Diarrhoeal illness occurring after 6 hours
60
Features of amoebiasis gastroenteritis
Gradual onset bloody diarrhoea, abdominal pain, and tenderness which may last several weeks
61
Which pathogens causing gastroenteritis have incubation period of 1-6 hours
Staph aureus
Bacillus cereus
62
Which pathogens causing gastroenteritis have incubation period 12-48 hours
Salmonella
E coli
63
Which pathogens causing gastroenteritis have incubation period 48-72 hours
Shigella
Campylobacter
64
Which pathogens causing gastroenteritis have incubation period >7 days
Giardiasis
Amoebiasis
65
Virus causing genital herpes
HSV-1 and HSV-2 (more so HSV-2)
66
Management of HSV in pregnancy
Elective section at term if primary attack of herpes after 28 weeks
Recurrent herpes in pregnancy treated with suppressive therapy, risk of transmission to baby is low
67
Virus causing genital warts
HPV 6 and 11
68
Virus causing cervical cancer
HPV 16, 18, 33
69
First line treatment for genital wards
Topical podophyllum if multiple, non-keratinised warts
Cryotherapy if solitary keratinised warts
70
Second line treatment for genital warts
Imiquimod
71
Treatment for giardiasis
Metronidazole
72
Features of hepatitis A
Flu like prodrome
Abdominal pain, typically RUQ
Tender hepatomegaly
Jaundice
Deranged LFTs
73
Features of acute hepatitis B
Fever
Jaundice
Raised LFTs
74
Complications of hepatitis B
- Chronic hepatitis (5-10%)
- Fulminant liver failure (1%)
- Hepatocellular carcinoma
- Glomerulonephritis
- Polyarteritis nodosa
- Cryoglobulinaemia
75
Risk factors for non-response to hep B vaccine
- Age over 40
- Obesity
- Smoking
- Alcohol excess
- Immunosuppression
76
Criteria for testing anti-HBs to assess response to hep B vaccine
- Risk of occupational exposure
- CKD
77
What anti-HBs level indicates adequate response
>100
78
What anti-HBs level indicates suboptimal response
10-100
79
Management of suboptimal response to hep B vaccine
One additional vaccine dose given. If immunocompetent, no further testing required
80
What anti-HBs level indicates non-responder
<10
81
Management of non-responder to hep B vaccine
Test for current or past infection
Give further vaccine course (3 doses again) and then testing
82
Management of non-responder to hep B vaccine after repeat course
HBIG for protection if exposed to virus
83
Management of hepatitis B infection
Pegylated interferon-alpha
84
Breastfeeding and hep C
Not contraindicated
85
Features of acute hep C infection
- Transient rise in serum aminotransferases/jaundice
- Fatigue
- Arthralgia
Only about 30% get these symptoms
86
Complications of chronic hep C
- Rheumatological probelms
- Sjorgens syndrome
- Cirrhosis
- Hepatocellular cancer
- Cryoglobulinaemia
- Porphyria cutanea tarda
- Membranoproliferative glomerulonephritis
87
Rheum problems in chronic hep C
Arthralgia
Arthritis
88
Management of chrnoic hep C
Combination of protease inhibitors e.g. sofosbuvir + daclatasvir or simeprevir, with or without ribavirin
89
SEs of ribavirin
Haemolytic anaemia
Cough
Teratogenic (no pregnancy for 6 months after stopping)
90
SEs of interferon alpha
Flu like symptoms
Depression
Fatigue
Leukopenia
Thrombocytopenia
91
Cause of Kaposi's sarcoma
HHV-8 (in HIV patient)
92
Features of Kaposi's sarcoma
Purple papules or plaques on skin or mucosa, e.g. GI, resp tract
Skin lesions may later ulcerate
Resp involvement → haemoptysis and pleural effusion
93
HIV treatment
At least 3 drugs - typically 2 nucleoside reverse transcriptase inhibitors (NRTI) and either protease inhibitor (PI) or non-nucleoside reverse transcriptase inhibitor (NNRTI)
94
Examples of NRTI
Zidovudine
Tenofovir
Didanosine
95
General SEs NRTIs
Peripheral neuropathy
96
SE tenofovir
Renal impairment
Osteoporosis
97
SEs zidovudine
Anaemia
Myopathy
Black nails
98
SEs didanosine
Pancreatitis
99
Examples of NNRTI
Nevirapine
EfavirenzS
100
SEs NNRTI
P450 enzyme interaction
Rashes
101
Examples protease inhibitors
Indinavir
Nelfinavir
Ritonavir
102
SEs protease inhibitors
Diabetes
Hyperlipidaemia
Buffalo hump
Central obesity
P450 enzyme inhibition
103
SEs indinavir
Renal stones
Asymptomatic hyperbilirubinaemia
104
SEs ritonavir
Potent inhibitor of P450
105
CXR findings PCP pneumonia
Bilateral interstitial pulmonary infiltrates
May be normal
106
Features of PCP pneumonia
Dyspnoea
Dry cough
Fever
Exercise induced desat
Very few chest signs
107
Management PCP pneumonia
Co-trimoxazole
IV pentamidine in severe cases
Steroids if hypoxic
108
Cause of infectious mononucleosis
EBV aka HHV-4
109
Features of infectious mononucleosis
- Sore throat
- Lymphadenopathy (anterior and posterior triangles)
- Pyrexia
- Palatal petechiae
- Splenomegaly (50%)
- Hepatitis, transient rise in ALT
- Lymphocytosis
- Haemolytic anaemia
110
Infectious mononucleosis + amoxicillin =
Maculopapular, pruritic rash
111
Diagnosis of infectious mononucleosis
Heterophil antibody test (monospot test)
112
Mode of administration of child flu vaccine
Intranasal
113
Nasal flu vaccine live or inactivated
Live
114
Contraindications nasal flu vaccine
Immunocompromised
Aged <2
Current febrile illness or blocked nose/rhinorrhoea
Current wheeze or history of severe asthma
Egg allergy
Pregnancy/breastfeeding
If child taking aspirin (risk of Reye's syndrome)
115
Adult flu vaccine live or inactivated?
Inactivated
116
Contraindications adult flu vaccine
Hypersensitivity to egg protein
117
Features of Legionnaire's disease
Flu like symptoms inclduing fever
Dry cough
Relative bradycardia
Confusion
Lymphopenia
Hyponatraemia
Deranged liver function test
Pleural effusion
118
Diagnosis of Legionnaire's disease
Urinary antigen
119
CXR findings Legionnaire's disease
Mid to lower zone predominance of patchy consolidation
Pleural effusions in 30%
120
Management of Legionnaires disease
Erythromycin/clarithromycin
121
Features leptospirosis
Early phase (lasts around a week):
- Mild or subclinical
- Fever
- Flu like symptoms
- Subconjunctival redness/haemorrhage
Second immune phaes (Weil's disease)
- AKI
- Hepatitis - jaundice and hepatomegaly
- Aseptic meningitis
122
Management leptospirosis
Mild-to-moderate - doxycycline or azithromycin
Severe disease - IV benzylpencillin
123
How is leptospirosis spread
Rat urine
124
Diagnosis of Lyme disease
Clinical diagnosis of erythema migrans present
ELISA antibodies to Borrelia burgdorferi if doubt. If neg and still suspected, repeat ELISA in 4-6 weeks. If still negative and symptomatic for 12 weeks, immunoblot test
125
Management of Lyme disease
Doxycycline if early disease, amox if contraindicated
Ceftriaxone if disseminated disease
126
Features of plasmodium vivax
Found in central America and Indian subcontinent
Fever, headache, splenomegaly
Cyclical fever every 48 hours
127
Features of plasmodium ovale
Typically from Africa
Cyclical fever every 48 hours
Fever, headache, splenomeglay
128
Features of plasmodium malariae
Fever, headache, splenomegaly
Nephrotic syndrome
129
Treatment for non-falciparum malaria
In chloroquine sensitive areas, either artemisinin based combo therapy (ACT) or chloroquine
In resistant areas, ACT
Patients with ovale or vivax - primaquine following acute treatment to prevent relapse
130
Options for malaria prophylaxis
Malarone (atovaquone and proguanil)
Chloroquine
Doxycycline
Lariam (meflouquine)
Paludrine (proguanil)
131
SEs malarone
GI upset
132
When to take malarone prophylaxis
1-2 days before
7 days after
133
SEs chloroquine
Headache
134
Contraindications chloroquine
Epilepsy
135
When to take chloroquine
1 week before
4 weeks after
Taken weekly
136
SEs doxycyline (malaria prophylaxis)
Photosensitivity
Oesophagitis
137
When to take doxycycline malaria prophylaxis
1-2 days before
4 weeks after
138
SEs mefloquine
Dizziness
Neuropsychiatric disturbance
139
CIs mefloquine
Epilepsy
140
When to take mefloquine malaria prophylaxis
2-3 weeks before
4 weeks after
141
When to take proguanil malaria prophylaxis
1 week before
4 weeks after
142
Considerations pregnancy and malaria
Avoid travelling to regions where malaria endemic, diagnosis difficult as parasites may not be detected due to placental sequesteration
143
Malaria prophylaxis in pregnancy
Chloroquine ok
Proguanil - needs folate supplements
Malarone - avoid, if essential then folate
Avoid mefloquine
Doxy contraindicated
144
Malaria prophylaxis for children
Avoid travel
DEET spray - repels 100% mosquitos if used correctly, can be used from 2 months
Doxycyline if over 12
145
CSF findings in bacterial meningitis
- Cloudy
- Low glucose (<1/2 plasma)
- High protein (>1g/L)
- 10-5,000 white cells
146
CSF findings viral meningitis
- Clear/cloudy
- 60-80% plasma glucose
- Normal/raised protein
- 15-1000 white cells
147
CSF findings tuberculous meningitis
- Slightly cloudy, fibrin web
- Low glucose (<1/2 plasma)
- High protein (>1g/L)
- 30-300 white cells
148
CSF findings fungal meningitis
- Cloudy
- Low glucose
- High protein
- 20-200 white cells
149
Empirical antibiotics bacterial meningitis <3 months
IV cefotaxime and amox
150
Empirical antibiotics bacterial meningitis 3 months - 50 years
IV cefotaxime or ceftriaxone
151
Empirical antibiotics bacterial meningitis
IV cefotaxime (or ceftriaxone) and amoxicillin (or ampicillin)
152
Antibiotics meningococcal meningitis
IV benzylpenicillin or cefotaxime (or ceftriaxone)
153
Antibiotics pneumococcal meningitis
IV cefotaxime (or ceftriaxone)
154
Antibiotics haemophilus influenzae meningitis
IV cefotaxime (or ceftriaxone)
155
Antibiotics listeria meningitis
IV amoxicillin (or ampicillin) and gentamicin
156
Antibiotics meningitis contact prophylaxis
Ciprofloxacin or rifampicin
157
Antibiotics MRSA
Vancomycin
Teicoplanin
Linezolid
158
Treatment mumps
Rest
Paracetamol
Notifiable
159
Complications mumps
Orchitis
Hearing loss
Meningoencephalitis
Pancreatitis
160
Features of mycoplasma pneumonia
Prolonged and gradual onset
Flu like symptoms preceding dry cough
Bilateral consolidation on XR
161
Complications mycoplasma pneumonia
- Cold agglutins → haemolytic anaemia, thrombocytopenia
- Erythema multiforme, erythema nodosum
- Meningoencephalitis, Guillain-Barre syndrome
- Bullous myringitis
- Pericarditis/myocarditis
- Hepatitis, pancreatitis
- Acute glomerulonephritis
162
Treatment mycoplasma pneumonia
Doxycycline or macrolife (erythromycin/clarithromycin)
163
Presentation of parvovirus B19
Erythema infectiosum aka slapped cheek syndrome
Pancytopenia in immunosuppressed
Aplastic criss in sickle cell
Hydrops fetalis if pregnant
164
Features of erythema infectiosum
Mild feverish illness
Bright red cheeks appear as child feels better
Can be triggered by warmth for months afterwards
165
Most common cause of CAP
Streptococcus pnuemoniae
166
CAP after flu
Staph aureus
167
Pneumonia in alcoholics
Klebsiella
168
PEP hep A
Human normal immunoglobulin (HNIG) or hep A vaccine
169
PEP hep B positive source
If known responder to vaccine, booster dose given
If non-responder (<10), hep B immune globulin and booster vaccine
170
PEP hep B unknown source
If known responder to vaccine, consider booster
If non-responder, HBIG and vaccine
If in process of being vaccinated, accelerated course
171
PEP hep C
Monthly PCR - if seroconversion, inferon +/- ribavirin
172
PEP HIV
Combination of oral anti-retrovirals ASAP (ideally within 1-2 hours, up to 72 hours) for 4 weekse
Serological testing 12 weeks following completion of PEP
173
PEP varicella zoster
VZIG in IgG neg preg women/immunocompromised
174
Rabies treatment (animal bite in at risk countries)
Wash wound
If immunised, 2 further doses of vaccine
If unimmunised, human rabies immunoglobulin (HRIG) given with full course of vaccination - if possible, administer locally around wound
175
Most common cause of bronchiectasis exacerbations
H influenzae
176
Rubella features
Prodrome - low grade fever
Maculopapular rash, initially on face → body
Suboccipital and postauricular lymphadenopathy
177
Complications rubella
Arthritis
Thrombocytopenia
Encephalitis
Myocarditis
178
Features of chancroid
Painful genital ulceration
Unilateral painful inguinal lymph node enlargement
Sharply defined, ragged, undermined border
179
Cause of lymphogranuloma venereum
Chlamydia trachomatis
180
Features of lymphogranuloma venereum
Stage 1 - small painless pustule which later forms ulcer
Stage 2 - painful inguinal lymphadenopathy
Stage 3 - proctocolitis
181
Treatment for lymphogranuloma venereum
Doxycycline
182
Features primary syphilis
Chancre (painless ulcer at site of sexual contact)
Local non-tender lymphadenopathy
Often not seen in women (may be on cervix)
183
Features secondary syphilis
Systemic features - fevers, lymphadenopathy
Rash on trunk, palms, soles
Buccal 'snail track' ulcers
Condylomata lata (painless, warty lesions on genitalia)
184
Features tertiary syphilis
Gummas (granulomatous lesions of skin and bones)
Ascending aortic aneurysms
General paralysis of the insane
Tabes dorsalis
Argyll-Robertson pupil
185
Features of congenital syphilis
- Blunted upper incisor teeth
- Rhagades (linear scars at angle of mouth)
- Keratitis
- Saber shins
- Saddle nose
- Deafness
186
Treatment syphilis
IM benzathine penicillin, doxy if contraindicated
187
What can occur after antibiotic treatment for syphilis
Jarisch-Herxheimer reaction - fever, rash, tachycardia after first dose of antibiotic. No wheeze or hypotension.
188
Routine tetanus vaccine given at...
2, 3, 4 months
3-5 years
13-18 years
189
What is classified as tetanus prone wound
Puncture type injuries in contaminated environment, e.g. gardening injuries
Wounds containing foreign bodies
Compound fractures
Wounds or burns with systemic sepsis
Certain animal bites and scratches
190
What is classified as high risk tetanus prone wounds
Heavy contamination with material likely to contain tetanus spores, e.g. soil, manure
Wounds or burns with extensive devitalised tissue
Wounds or burns requiring surgical intervention
191
Management of tetanus prone wounds
If full course vaccines with last dose <10 years ago, no action
If full course vaccines with last dose >10 years ago, reinforcing dose of vaccine
If vaccination history incomplete or unknown, reinforcing dose of vaccine and tetanus immunoglobulin
192
Management of high-risk tetanus prone wound
If full course vaccines with last dose <10 years ago, no action
If full course vaccines with last dose >10 years ago, or vaccine history unknown/incomplete reinforcing dose of vaccine and tetanus immunoglobulin
193
Examples of tetracyclines
Doxycycline
Tetracycline
194
Adverse effects tetracyclines
Discolouration of teeth (should not be used <12 years of age)
Photosensitivity
Angioedema
Black hairy tongue
195
Tetracyclines in pregnancy/breastfeeding
Do not use due to risk of teeth discolouration
196
Toxoplasmosis in immunosuppressed/HIV can cause...
Cerebral toxoplasmosis
Chorioretinitis
197
Features of cerebral toxoplasmosis
Constitutional symptoms
Headache
Confusion
Drowsiness
198
CT features cerebral toxoplasmosis
Usually single or multiple ring enhacing lesions, mass effect may be seen
199
Management cerebral toxoplasmosis
Pyrimethamine plus sulphadiazine for at least 6 weeks
200
Features of congenital toxoplasmosis
Neuro damage
- Cerebral calcification
- Hydrocephalus
- Chorioretinitis
Opthalmic damage
- Retinopathy
- Cataracts
201
Features of trichomonas vaginalis
Vaginal discharge - offensive, yellow/green, frothy
Vulvovaginitis
Strawberry cervix
pH >4.5
Usually asymptomatic in men, can cause urethritis
202
Investigation findings trichomonas vaginalis
Microscopy of wet mount shows motile trophozoites
203
Management trichomonas vaginalis
Oral metronidazole 5-7 days (or one off dose 2g metronidazole)
204
Diagnosis of latent TB
Positive tuberculin skin test or interferon gamma release assay, with normal CXR to exclude active TB
205
Treatment latent TB
3 months of isonazid + pyridoxine and rifampicin (if under 35 and hepatotoxicity a concern)
6 months of isonidazid with pyridoxine (if interactions with rifamycins a concern, e.g. HIV, transplant)
206
Treatment active TB
2 months - rifampicin, isoniazid, pyrizinamide, ethambutol
Then next 4 months - rifampicin, isoniazid
207
Treatment meningeal TB
Prolonged treatment (at least 12 months) wtih steroids
208
Live attenuated vaccines
BCG
MMR
Intranasal flu
Oral rotavirus
Oral polio
Yellow fever
Oral typhoid
209
Inactivated vaccines
Rabies
Hepatitis A
IM flu
210
Toxoid vaccines
Tetanus
Diptheria
Pertussis
211
Subunit/conjugate vaccine
Pneumococcus
Haemophilus
Meningococcus
Hep B
HPV
