infectious Disease

Question 1

First and second line treatment for Syphillis?

Answer 1

1: Penicillin G 2: Doxycycline (not if preggos)

Question 2

First and second line treament for cellulitis

Answer 2

1. Flucloxacillin
2. Clindamycin

**severe benzylpenicillin + flucloxacillin

Question 3

Pneumonia in an alcoholic? Causative agent?

Answer 3

Klebsiella pneumoniae

Question 4

widespread skin rash which he describes as lots of pink rings around a pale centre.

Answer 4

erythema multiforme

Question 5

Causes of erythema multiforme

Answer 5

Infection

• mycoplasma pneumoniae
• Herpes simplex

Medications

• antibiotics
• NSAIDs
• anticonvulsants

tackle underlying cause! may be resloved in 2-4 weeks

Question 6

Pneumocystis jiroveci pneumonia usually only occurs in patients with…

Answer 6

HIV

• Look for a CD4 count of <200/mm³

Question 7

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)

What’s the diagnosis and treatment?

Answer 7

Bacterial vaginosis!

Treat with oral metronidazole for 7 days

alt. is clindamycin

Question 8

What is the 4 part drug regimen used for TB treatment?

Answer 8

RIPE

• Rifampicin
• isonazid
• Pyranzinamide
• Ethambutol (if no visual issues)

Question 9

Where do you get leptospirosis and what are the symptoms

Answer 9

through rat urine

• fever
• flu-like symptoms
• renal failure (seen in 50% of patients)
• jaundice
• subconjunctival haemorrhage
• headache, may herald the onset of meningitis

Treat w benxypenicllin or doxy

Question 10

Dengue fever is what type of infection and what is it from?

Answer 10

a viral infection which can progress to viral haemorrhagic fever (also yellow fever, Lassa fever, Ebola)

From mosquito bites!

Question 11

Incubation period, symptoms and treatment of Dengue Fever?

Answer 11

7 days incubation period

• causes headache (often retro-orbital)
• fever
• myalgia
• pleuritic pain
• facial flushing (dengue)
• maculopapular rash

Treatment isentirely symptomatic

Question 12

What is the major firstline treatment for most forms of meningitis?

Answer 12

IV cefotaxime

Question 13

What are the live vaccinations to be aware of?

Answer 13

• BCG
• MMR
• oral polio
• yellow fever
• oral typhoid

Question 14

Erythema_____________ (also known as fifth disease or ‘slapped-cheek syndrome’

is caused by what infectious agent?

Answer 14

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

is caused by Parovirus B19

Question 15

In patients with suspected meningitis, organisms stained with india ink point to what organism as a cause?

Answer 15

Cyrptococcus neoformans

encapsulated yeast and an obligate aerobe, often in immunocomprimised individuals

Question 16

Lyme disease is caused by the ________ and is spread by ___

Answer 16

Caused by: spirochaete Borrelia burgdorferi

spread by ticks

Question 17

First line treatment for diabetic neuropathy

Answer 17

first-line treatment: amitriptyline, duloxetine, gabapentin or pregabalin

Question 18

Why should amitryptillin be avoided in patients with BPH

Answer 18

***amitryptilin should not be used in the setting of BPH due to increased urinary retention risk

Question 19

What are differentials for a ‘starry sky’ appearance?

Answer 19

Burkitts lymphoma is a B-cell cancer

The ‘sky’ = densely packed malignant B cells

the ‘stars’ = fixation artefact derived from debris-filled macrophages.

Question 20

Why does burkitts lymphoma sometimes present with a sore throat and what other weird ways can it present?

Answer 20

Closely associated with EBV!

Also as its rapidly growing it can compress nerve roots (eg brachial plexus) causing limb weakness

Question 21

if diarrhoea and gastroenteritis symptoms persist >3weeks what organism should you consider

Answer 21

Giardiasis

Question 22

EBV is associated with what malignancys

Answer 22

Hodgkins lymphoma

Burkitts lymphoma

Nasopharyngeal carcinoma

Question 23

Genital warts are caused by HPV strains

Answer 23

6 and 11

Question 24

Physical features of acromegaly

Answer 24

big hands, supraorbital ridge, big tongue, wide-spaced teeth, carpel-tunnel syndrome, hypertension, increased sweatiness

***can have compression symptoms if it’s a large pituitary macroadenoma!

Question 25

Acromegaly puts you at a higher risk of?

Answer 25

cardiovascular events and colorectal cancer

Question 26

Investigations and diagnostic tests of acromegaly?

Answer 26

Oral glucose tolerance test with GH measurement: DIAGNOSTIC

Serum insulin like growth factors (IGF-1) reflects 24hr GH levels and is a screening test

Question 27

Acromegaly treatment

Answer 27

• Surgery
• Drugs (octreotide, dopamine if it cosecretes prolactin)
• radiotherapy

Question 28

What pneumonia indcing organism commonly causes reactivation of the herpes simplex virus resulting in ‘cold sores’

Answer 28

Streptococcus pneumoniae commonly causes reactivation of the herpes simplex virus resulting in ‘cold sores’

Question 29

Pepperpot skull is a characteristic X-ray finding of

Answer 29

hyperparathyroidism

High circulating levels of parathyroid hormone stimulate increased osteoclast activity. Increased uptake of trabecular bone leads to the formation of multiple small radiolucent lesions of the skull which gives the appearance of a pepperpot (the finding is sometimes called the salt and pepper sign). A similar appearance can also be seen in multiple myeloma (although in myeloma, it is more accurately called raindrop skull).

Question 30

Dx of IMN is done how and when?

Answer 30

heterophil antibody test (Monospot test)

Done in the second week

Question 31

What antibiotic can cause a black hairy tongue?

Answer 31

Tetracyclines (doxycycline or tetracycline)

From defective desquamation of the villi (can be other colours)

Question 32

What to test for to confirm drug-induced Lupus?

Answer 32

Anti-histone antibodies (80-90%)

ANA positive in 100%

sDNA negative

Question 33

Blue sclera is associated with

Answer 33

osteogenesis imperfecta