Question 1

SBA1

One day old baby girl born after prolonged delivery, becomes drowsy High temp, tachycardia, tachypnoea

On examination, T: 38.9, HR: 170bpm, RR: 30. Which is the most likely causative agent?

A.Neisseria meningitis

B.Streptococcus pneumonia

C.Listeria monocytogenes

D.Group B streptococcus

E.E. Coli

Accepted Answer

D Group B streptococcus

Question 2

SBA2

21 y old wild med student- neck stiffness + photophobia, non blanching rash What would LP findings show?

A.Turbid colour, Increased polymorphs, normal monocytes, low glucose, high protein

B.Clear colour, normal polymorphs, high lymphocytes, normal glucose, high protein

C.Turbid colour, normal polymorphs, high lymphocytes, low glucose, normal protein

D.Cloudy colour, normal polymorphs, high lymphocytes, low glucose, high protein

E.Clear colour, high polymorphs, normal lymphocytes, low glucose, high protein

Accepted Answer

- Neisseria meningitis so bacterial so: Colour: Turbid Polymorphs: High Monocytes: Normal Glucose: Low Protein: High

Question 3

SBA3

A 72-year-old patient with a new onset murmur, fever and clubbing presents with blood in his stools and weight loss over the past 5 months. Which is the most likely causative agent?

A.Staph aureus

B.Staph epidermis

C.Streptococcus viridian

D.Streptococcus bovis

Enterococci

Accepted Answer

D Streptococcus bovis Patient has Infective endocarditis AND Colorectal cancer [NB Infective endocarditis causes weight loss but would not cause blood in stool] This pathogen causes both

Question 4

SBA4

Fifteen year old boy with Di George syndrome had a dental tooth extraction two weeks ago

Visits GP. New murmur on left sternal edge on auscultation.

Basic observations:

BP 110/80, HR: 95, Temperature: 38.5, SaO2 98% on air.

What is the most likely causative agent?

A.Staph aureus

B.Staph epidermis

C.Streptococcus viridian

D.Streptococcus bovis

Enterococci

Accepted Answer

C.Streptococcus viridian

Question 5

SBA5

A 24 year old medical student comes back from their holiday and presents to A&E with profuse diarrhoea of rice water appearance. There is no blood. What is the most likely causative agent?

A.Entamoeba histolytica

B.Staph aureus

C.Bacillus cereus

D.E. Coli

Vibrio cholera

Accepted Answer

E Vibrio cholera NB: Rice water diarrhoea= buzz word for vibrio cholera

Question 6

SBA 6

A 40 year old woman presents to A&E with bloody, foul smelling diarrhoea. She went to a barbeque yesterday where she suspects she ate undercooked chicken. She has a fever and severe abdominal pain. What is the most likely causative agent?

A.Campylobacter

B.Shigella

C.Bacillus cereus

D.E. coli

Salmonella

Accepted Answer

A. Campylobacter Campylobacter is more common than salmonella so best answer

Question 7

What are contraindications for lumbar puncture?

Accepted Answer

- Signs of raised ICP - Superficial infection over LP site - Coagulopathy

Question 8

What sign means you should admit patient to hospital for meningitis immediately?

Accepted Answer

Non-blanching rash = indicates Meningococcal septicaemia

Question 9

Management in hospital of meningitis

Accepted Answer

_Meningococcal septicaemia_ IV benzylpenicillin Single dose _Bacterial meningitis_ - IV ceftriazone - Consider dexamethasone [but not if meningococcal septiceamia suspected] - Cover listeria with ampicillin - If consciousness affected- IV acyclovir [cover incase encephalitis]

Question 10

What is given as prophylaxis to people in close contact with someone with meningitis?

Accepted Answer

Rifampicin Ciprofloxacin

Question 11

Infective endocarditis Definition Epidemiology Aetiology [Four causative organisms] Risk factors Symptoms Signs Buzzwords Investigations Management Complications

Accepted Answer

Infective endocarditis Definition Infection of endocardial structures [mainly heart valves] Epidemiology Uncommon Aetiology - Bacterial 1. Streptococci [abnormal valves] 2. Staphycocci [prosthetic valves, IV drug use- risk factors which are not disease] 3. Enterococci -Other organisms - HACEK Risk factors Abnormal heart valves- [Streptococcus viridans] Prosthetic heart valves [Staphylococcus epidermidis] IV drug use- [Staphyloccous aureus] Turbulent blood flow- ventricular septal defect/patent ductus arteriosus Recent dental procedures Symptoms - Weight loss - Fatigue/malaise - Fever - Confusion - Arthralgia/Myalgia Signs - Pyrexic - New murmur [Mitral \> Aortic \> Tricuspid \> Pulmonary] - Tachycardia - Anaemia - Clubbing [strep viridans especially- b/c more chronic] - Splenomegaly - Vasculitic lesions - Osler's node-fingers, painful [Ouch] - Janeway lesions - not painful - Splinter haemorhhages - Roth spots - petechiae on retina [Lesions get disloged and bacteria goes to small vessels] - Lesions on pharyngeal + conjunctival mucosa OR Mnemonic for presentation: FROM JANE Fever Roth Spots Osler's nodes Murmur Janeway lesions Anaemia Nail bed/splinter haemorrhage Emboli- of vegetations/bacteria Buzzwords New murmur Dental procedure Prosthetic valve Vegetation on echo Indwelling catheter Right heart [can also affect left, but most other pathologies don't affect right side, so if R, consider infective endocarditis] Investigations - Blood cultures- THREE, taken one hour apart within a 24 hour period - Bloods: FBC- anaemia [normocytic], high neutrophils U + E High ESR High CRP Rheumatoid factor positive - Transthoracic echocardiogram- Urgent [if nothing shown, transoesophageal echo more specific] - Dukes classification Management -Broad spectrum antibiotics before cultures come back [If can wait until after cultures come back to give specific Abx, then do] Antibiotics for four to six weeks [at least 6 weeks if prosthetic valve] Native valves - Benzylpenicillin + gentamicin - Strep viridans - Flucloxacillin - Staph aureus _Prosthetic valves_ - Flucloxacillin/Vancomycin + rifampicin + gentamycin - Staph epidermidis _Penicillin allergic/resistant_ - Vancomycin instead of penicillin Complications Congestive cardiac failure Valve incompetence Aneurysm + rupture Systemic embolisation Renal failure Glomerulonephritis

Question 12

Gastroenteritis Definition Aetiology-fill in table Viral organisms Bacteria Protozoal Symptoms Investigations Management

Accepted Answer

Gastroenteritis Definition Acute inflammation of GI tract lining associated with nausea, vomiting, diarrhoea and abdo pain Aetiology _Viral organisms_ Rotavirus, adenovirus, calcivirus, astrovirus _Bacterial organisms_ Campylobacter jejuni, E Coli [0157]/haemorhhagic e coli, Salmonella, Shigella, Vibrio cholera, Bacillus cereus, C difficile _Protozoal_ Entaemoaba histolytica, giardia lamblia, cryptosporidians parvus _Bacterial causes of diarrhoea and history buzzwords_ BEVS CS Bacillus _cere_us [reheated rice, _cere_bral abscess] E Coli [leafy vegetables] Vibrio cholera [rice water stools, poor sanitation, shock] Salmonella [eggs, poultry, constipation, in Payer's patches in small intestine] C difficile [antibiotic use, \>70 y old, previous C diff, antiperistaltic drugs] Staph aureus [food, 1-6hr after eating] _Bacterial causes of dysentery [bloody diarrhoea] and history buzzwords_ CHESS Campylobacter jejuni [uncooked poultry] Haemorrhagic E coli [leafy vegetables, develops into haemolytic uraemic syndrome] Entamoeba histolytica [poor sanitation, MSM, tropical climates] Shigella [person to person contact, poor sanitation, MSM] Salmonella [eggs] Symptoms Nausea Vomiting Diarrhoea {+/- blood] Abdo pain Fever + malaise Investigations _Examination:_ Dehydration- mucous membranes, cap refill, skin turgor Temperature Shock- high HR, low BP _Bloods:_ FBC U + E [low K+ if severe diarrhoea and vomiting] ESR + CRP- high _Stool MC+S [if systemic signs of illness]_ Bacteria, ova cyst/eggs, parasites Management If no systemic illness: Bed rest Oral rehydration solution- electrolyte replacement No stool MCS If systemic illness: [Fever\>39C, \>two weeks, dehydration, blood in stool] Admit to hospital Oral fluid/ IV fluid if severe vomiting Stool MC+S [direct faecal smear + culture] + give antibiotics if bacterial cause identified Check hydration -mucous membranes -skin turgor -capillary refill Check for shock -HR -BP Temperature Bloods - - - -[low K+] -Stool MCS for _._,_ usually only do if -Travel abroad? -Prolonged symptoms Management No systemic signs - - - Severe illness - - - - - -

Question 13

What causative organism does non blanching rash suggest in meningitis?

Accepted Answer

Neisseria meningitidis

Question 14

A 37-year-old bride-to-be returned from Jamaica 3 days ago, where she partied and explored the local cuisine with her best friends. She presents to her GP complaining of being jaundiced with right upper quadrant pain and fever. What is the most likely cause of her symptoms?

A.Alcoholic hepatitis

B.Gall stones

C.Cholecystitis

D.Hepatitis A

Hepatitis C

Accepted Answer

D Hepatitis A [Hep A is faeco-orally transmitted]

Question 15

Hepatitis Definition Aetiology Transmission routes [viral] Symptoms + different presentations of different viral hepatitis Investigations Management [for different types of viral hepatitis]

Accepted Answer

Hepatitis Definition Inflammatory liver disease Aetiology Viral-A to E Alcoholic Autoimmune Transmission routes _Hep A + E:_ Faeco oral [vowels hit the bowels] _Hep B:_ Blood - transfusion, IV drugs Birthing- mother to child, perinatal Baby making- MSM, unprotected sex _Hep C_ Contaminated blood products [transfusion, IV drugs] _Hep D:_ Needs infection with hep B to enter- attaches to hep B antigen [Two Ds stacked on top of each infection makes a B] Symptoms Triad: Fever Jaundice Raised ALT + AST Also: Nausea Vomiting Anorexia RUQ pain _Hep A_ Acute Asymptomatic Travel history _Hep B_ Acute= 90%, chronic= only 10% _Hep C_ Chronic Risk of hepatocellular Carcinoma Hep E Enteric E- immunodeficiency Expectant mothers- pregnancy Epidemics- contaminated water Travel history Investigations FBC LFT U+E Clotting- prolonged PT time=liver damage [sensitive] Viral serology Viral PCR Ultrasound abdo- rule out liver malignancy Liver biopsy- monitor inflammation, cirrhosis Management [for different types of viral hepatitis Hep A + E= supportive treatment, avoid alcohol Hep B= acute= symptomatic supportive treatment, chronic= antiviral [peginterferon alpha, tenofovir] Hep C= Anti viral [NS5A inhibitor, NS3/4 protease inhibitor]

Infectious disease 2 Flashcards