Infectious Disease 2 Flashcards
Cutaneous larva migrans
Mx
Albendazole or Ivermectin
Rose spots and constipation
Caused by
Type of organism (-ve/+ve)
Typhoid
Salmonella
Gram-negative rods
HIV diarrhoea most common cause
- Cryptosporidium + other protozoa (most common)
Who should be given prophylaxis for PJP?
Common complication of PJP?
CD4 count < 20 should receive PCP/ PJP prophylaxis
Pneumothorax
Name three extrapulmonary manifestations in PJP Mx PJP (2)
hepatosplenomegaly
lymphadenopathy
choroid lesions
co-trimoxazole
IV pentamidine in severe cases
HPV
Which causes warts?
Which causes cervical cancer?
6&11
16&18
Age group for cervical cancer screening
Who else should be offered vaccine and why?
25-49 every 3 years
50-64 every 5 years
Boys and girls aged 12-13yo
Men who have sex with men under the age of 45 to protect against anal, throat and penile cancers
bilateral interstitial pulmonary infiltrates =
PJP
Listeria monocytogenes
+ve/-ve shape
dx
Mx
Gram-positive bacillus
Contaminated food unpasteurised dairy products
blood cultures
amoxicillin/ampicillin
Animals
‘scabby’ lesions around the mouth and nose
Humans
generally affects the hands and arms
initially small, raised, red-blue papules
later may increase in size to 2-3 cm and become flat-topped and haemorrhagic
Orf
condition found in sheep and goats although it can be transmitted to humans. It is caused by the parapox virus.
PEP
Hepatitis A
Human Normal Immunoglobulin (HNIG) or hepatitis A vaccine
PEP
Hepatitis B
If known responder to HBV vaccine then for booster dose
If non responder for HBIG + vaccine
PEP
Hep C
monthly PCR - if seroconversion then interferon +/- ribavirin
PEP
HIV
Combi of antiretrovirals ASAP - can be started up to 72 hrs post exposure for 4 weeks
Serological testing at 12 weeks
PEP
Varicella
VZIG for IgG negative pregnant women/immunosuppressed
Sepsis scoring system
qSOFA >=2 = greater risk of mortality
Respiratory rate > 22/min
Altered mentation
Systolic blood pressure < 100 mm Hg
papulovesicular lesions where the skin has been penetrated by infective larvae e.g. soles of feet and buttocks
larva currens: pruritic, linear, urticarial rash
if the larvae migrate to the lungs a pneumonitis similar to Loeffler’s syndrome may be triggered
=
Strongyloides stercoralis
Strongyloides stercoralis
What is it?
Rx
human parasitic nematode worm
larvae are present in soil and gain access to the body by penetrating the skin
Rx ivermectin and albendazole
Sulfonamides
Example
sulfamethoxazole
co-trimoxazole
multiple painful ulcers =
genital herpes HSV 2
Haemophilus ducreyi. =
painful genital ulcers associated with unilateral, painful inguinal lymph node enlargemen
Chancroid
Lymphogranuloma venereum (LGV) is caused by
chlamydia
What it Lymphogranuloma venereum (LGV)?
Rx
stage 1: small painless pustule which later forms an ulcer
stage 2: painful inguinal lymphadenopathy
stage 3: proctocolitis
doxycycline
questions referring to sewage workers, farmers, vets or people who work in an abattoir =
Mx
Leptospirosis
high-dose benzylpenicillin or doxycycline
Influenza children
How is it given
When is it first given?
Live or inactive?
it is given intranasally
the first dose is given at 2-3 years, then annually after that
it is a live vaccine
CI for flu vaccine in kids
immunocompromised
aged < 2 years
current febrile illness or blocked nose/rhinorrhoea
current wheeze (e.g. ongoing viral-induced wheeze/asthma) or history of severe asthma (BTS step 4)
egg allergy
pregnancy/breastfeeding
if the child is taking aspirin (e.g. for Kawasaki disease) due to a risk of Reye’s syndrome
SE fluc vaccine kids
blocked-nose/rhinorrhoea
headache
anorexia
Types of influenza and most common
three types of influenza virus; A, B and C. Types A and B account for the majority of clinical disease.
Who is given the influenza vaccine?
> 65yo
Healthcare professionals
Comorbidities
Pregnant
CI for flu vaccine in adults
hypersensitivity to egg protein
Drowsiness with meningitis symptoms could indicate?
Mx
Meningoencephalitis
IV ceftriaxone and aciclovir
What is the most common cause of non-falciparum malaria?
Cyclical fever every how many hrs for each case?
Plasmodium vivax
Plasmodium ovale and Plasmodium malariae accounting for the other cases.
Mx plasmodium ovale and vivax (2)
Acute treatment = chloroquine
primaquine to be given alongside it to prevent relapse
Most common malaria Prophylaxis meds (4)
Plasmodium falciparum
- Malarone (proguanil + atovaquone)
- Chloroquine
- Doxy
- Lariam (mefloquine)
swimmers’ itch =
RF for which condition
Mx
Which organ is impacted? (three features)
schisto
squamous cell bladder cancer
single oral dose of praziquantel
Bladder - therefore haematuria, increased frequency, bladder calcification
doxy SE (2)
- photosensitivity
2. oesophagitis
Lumbar puncture show a yeast and a capsule in the CSF stained with India ink =
cryptococcal meningitis
Faget’s sign =
Slow pulse + temperature seen in Yellow fever
Yellow fever typical acute symptoms (4)
fever
muscle pain
loss of appetite
N&V
Riverfisherman
Haemturia
Jaundice
=
Weil’s disease
Floaters, visual field defects in a HIV +ve pt =
CMV retinitis
Giardia mx
metro
Rocky mountain spotted fever =
Gram +ve/-ve
ricketssia ricketsii
Gram -ve
Life long scar formation =
Lieshmoniasis
River blindness
onchocherciasis
Paul Bunnel test =
Mono
Mx agitation and confusion in palliative patients
- Haloperidol
2. chlorpromazine, levomepromazine
Management of hiccups in palliative care (3)
- chlorpromazine
- haloperidol, gabapentin
- dexamethasone is also used, particularly if there are hepatic lesions
Palliative care pain First line what should be prescribed with it what can be prescribed with it breakthrough pain how to work out the dose? percentage increase when stepping up
- MR or IR morphine
- 20-30mg of MR a day with 5mg for breakthrough pain
- must be prescribed laxatives with it
- +/- anti-emetic
1/6th total dose
30-50%
Palliative care pain
If renal disease which pain relief?
mild - mod Oxycodone
severe - lfentanil, buprenorphine and fentanyl
Metastatic bone pain management (3)
- strong opioids
- bisphosphonates
- radiotherapy
Conversions Oral morphine to Oral oxycodone Oral tramadol to Oral morphine Oral codeine to Oral morphine oral morphine to subcutaneous morphine
/ 1.5-2
/10
/10
/2
Carcinogens Nitrosamines Aniline dyes Aflatoxin Bleomycin
Gastric + oesophageal
TCC
HCC
can cause pulmonary fibrosis
Mx congenital toxoplasmosis
Rx for infected mother during pregnancy =
spiramycin
Listeria in pregnancy
Mx
amoxi and gent
Recent trip abroad Presenting symptom = headache Diurnal variation with fever Giemsa stained thick and thin peripheral blood smears = ?
Malaria
Week 1: diffuse AP, constipation, inflamed Peyer Patches, blanching, truncal maculopapules
Week 2: splenomegaly, bradycardia
Week 3: pea soup diarrhoea, bowel perf, abdo distension
Blood and bone marrow cultures for diagnosis?
Typhoid
Fever, facial flushing, myalgia, haemorrhagic manifestations
Thrombocytopenia, leucopenia
=
dengue
