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3B GH > Infectious disease > Flashcards

Infectious disease Flashcards

1
Q

what disease are sewage workers at risk of?

A

leptospirosis

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2
Q

what diseases are IVDU at risk of?

A

endocarditis
hep B/C, HIV
soft tissue infection

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3
Q

bugs most likely caught from restaurant

A

salmonella

campylobacter

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4
Q

unusual organism infections in HIv

A 
TB
PCP
toxoplasma
MAI [Mycobacterium avium complex]
cryptococcus
candidiasis
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5
Q

23 yr old female, 12 hr Hx of rapid onset severe headache, vomiting, neck stiffness, photophobia, fever,. Now drowsy, GCS 13/15, rash developing on abdo.
Likely diagnosis?

A

MENINGITIS WITH meningococcal septicemia

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6
Q

GP phones you in AMU about 23 yr old female, 12 hr Hx of rapid onset severe headache, vomiting, neck stiffness, photophobia, fever,. Now drowsy, GCS 13/15, rash developing on abdo.
Advice to GP?

A

give IM benzyl pneicillin

admit immediatelty

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7
Q

GP phones you in AMU about 23 yr old female, 12 hr Hx of rapid onset severe headache, vomiting, neck stiffness, photophobia, fever,. Now drowsy, GCS 13/15, rash developing on abdo.
Advice to GP if patient has penicillin allergy?

A

NO ben pen

admit

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8
Q

what is the triad of meningism?

A

headache, neck stiffness, photophobia

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9
Q

23 yr old female, 12 hr Hx of rapid onset severe headache, vomiting, neck stiffness, photophobia, fever,. Now drowsy, GCS 13/15, rash on abdo + limbs.

Temp 38.7, HR 98, BP 100/60.

Immediate Ix and Tx?

A

ABCDE!

cultures, ABG, CRP, FBC, clotting, U+E, UO [catheter]

cefotax/ceftriax

fluid resus [/inotropes/vasopressors]

O2 if sats require

[dex]

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10
Q

what rash would you expect to see in meningococcal septicaemia?

A

non-blanching petechial/purpuric rash

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11
Q

23 yr old female, 12 hr Hx of rapid onset severe headache, vomiting, neck stiffness, photophobia, fever,. Now drowsy, GCS 13/15, rash on abdo + limbs.

if the patient has been alert and orientated, with headache/fever/neck stiffness + NO RASH. what other Ix would you want to do?

A

LP

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12
Q

contraindications for LP

A

bleeding disorder
cardioresp compromise
local infection
^ICP [severe headache, reduced LOC, falling pulse, rising BP, vomiting, focal neurology, papilloedema

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13
Q

during or after an LP, what do you test the CSF for

A

pressure, appearance

glucose, protein, gram stain

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14
Q

2 organisms likely to cause meningitis in adults

A

neiss meningitidis

strep pneum

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15
Q

treatment of viral meningitis

A

self-limiting

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16
Q

what institution need to be informed of anyone diagnosed with a bacterial meningitis + what treatment might be advised for close contacts?

A

proper officer / consultant for communicable disease control [works for public health england]

ciprofloxacin [or rifampicin]

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17
Q

Ix in suspected malaria? What would you specifically do out of hours?

A 
FBC [anaemia, thrombocytopenic]
thick and thin films
U+E, urine output [AKI]
clotting [DIC]
glucose [hypo]
ABG [acidosis]
urinalysis [haemoglobinuria]
LFT, cultures

OOH: rapid diagnostic test

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18
Q

24 yr old, 1 day after returning from Kenya. Fever, headache, myalgia. Was “fully vaccinated” and took proguanil + chloroquine. Temp 39.5.

differentials

A 
MALARIA
typhoid
dengue
viral haemorrhagic fever
diptheria
yellow fever
ebola 
etc!
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19
Q

24 yr old, 1 day after returning from Kenya. Fever, headache, myalgia. Was “fully vaccinated” and took proguanil + chloroquine. Temp 39.5.
Haematologist reports she has plasmodium falciparum with a parasitaemia of 3%.
What do you do now?

A

artesunate IV then artemether-lumefantrine PO

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20
Q

24 yr old, 1 day after returning from Kenya. Fever, headache, myalgia. Was “fully vaccinated” and took proguanil + chloroquine. Temp 39.5.
Haematologist reports she has plasmodium falciparum with a parasitaemia of 3%.
how would you monitor her response to treatment?

A

daily parasite count

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21
Q

what are the complications of severe malaria

A 
pulm oedema/ARDS
AKI
impaired conscious/seizure
shock
hypoglycaemia
anaemia
spontaneous bleed/ DIC
acidosis
haemoglobinuria`
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22
Q

how many negative films do you need to exclude malaria?

A

3

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23
Q

what anti-malaria drugs can be used for prophylaxis?

A

chloroquine, proguanil, doxycycline, mefloquine, atorvaquone. e.g. malarone = atorvaquone-proguanil

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24
Q

AMU - 35 yr old male. Increasing SOB 10/7.
fevers, rigors, headache, myalgia 7/7.
Cough, dirty green sputum 7/7.
GP gave amoxi, no effect.
Pt returned from holiday in tenerife 10/7 ago.

HR 110, BP 110/80, RR 30, SpO2 92% OA, temp 38.5, signs of left lower lobe consolidation.

Diagnoiss~?

A

pneumonia

e.g. legionella

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25
Q

AMU - 35 yr old male. Increasing SOB 10/7.
fevers, rigors, headache, myalgia 7/7.
Cough, dirty green sputum 7/7.
GP gave amoxi, no effect.
Pt returned from holiday in tenerife 10/7 ago.

HR 110, BP 110/80, RR 30, SpO2 92% OA, temp 38.5, signs of left lower lobe consolidation.

Ix?

A 
CXR
FBC
U+E
LFT
cultures
sputum culture
CRP
atypical serology [legionella, mycoplasma, chlamydia]
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26
Q

name 5 markers of clinical severity ass. w/ increased risk of death in CAP

A

CURB-65

confusion
urea >7
RR>30
BP <90/60
>65
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27
Q

commonest cause of CAP

A

strep pneum

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28
Q

main complicaitons of pneumonia

A

abscess

empyema

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29
Q

complications of legionaires

A

multiorgan failure needing ITU, e.g. AKI

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30
Q

ABx for legionellla pneumonia

A

IV clarith [+ rifampicin if ^severity]

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31
Q

whats the risk of using non-prokinetic antiemetics in D+V

A

toxic megacolon/ perf

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32
Q

50 yr old fishmonger, 3 day Hx of ^^^D+V, no blood or mucous.
Ate shellfish + turkey day before, no travel Hx.

differentials including likely palthogens

A

bacterial/ viral [norovirus] gastroenteritis

[IBD/IBS]

campylobacter, salmonella [mild can present without blood], noro

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33
Q

50 yr old fishmonger, 3 day Hx of ^^^D+V, no blood or mucous.
Ate shellfish + turkey day before, no travel Hx.

Investigations?

A

stool culture
blood culture
FBC
U+E

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34
Q

50 yr old fishmonger, 3 day Hx of ^^^D+V, no blood or mucous.
Ate shellfish + turkey at restaurant day before, no travel Hx.
Mx?

A

oral rehydration salts
encourage oral fluids, may need IV
[prokinetic antiemetics - metoclop, domperidone]

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35
Q

50 yr old fishmonger, 3 day Hx of ^^^D+V, no blood or mucous.
Ate shellfish + turkey at restaurant day before, no travel Hx.

public heath issues?

A

tell CCDC

stop work as fishmonger to prevent spread

CCDC will investigate restaurant

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36
Q

which bugs cause inflammation of the termninal large bowel, causing bloody mucous-y diarrhoea [dysentery], tenesmus.

A

shigella

salmonella

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37
Q

20 yr old plumber admitted with 3 day history of painful swelling of left leg and groin.
Generally unwell, fever, rigors.
Insulin-dependent DM.
Temp 38, pulse 108, BP 120/80.
Marked area of swelling and erythema over left shin spreading twards ankle + knee - warm/tender.
Also tender palpable lymph nodes in groin. No breaks in skin.
high WCC, CRP and BM.
Differntials?

A

cellulitis
DVT
charcot joint

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38
Q

20 yr old plumber admitted with 3 day history of painful swelling of left leg and groin.
Generally unwell, fever, rigors.
Insulin-dependent DM.
Temp 38, pulse 108, BP 120/80.
Marked area of swelling and erythema over left shin spreading twards ankle + knee - warm/tender.
Also tender palpable lymph nodes in groin. No breaks in skin.
high WCC, CRP and BM.

Investiagtions?

A

rule out DVT: doppler US

cultures

D-dimer would be high in either cellulitis or DVT due to inflamm

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39
Q

most likely pathogens for cellulitis

A

staph aureus

strep pyogenes [gram +ve group A beta haemolytic]

40
Q

Mx of cellultitis

A

IV fluclox

41
Q

20 yr old, 3 day history of painful swelling of left leg and groin. Unwell, fever, rigors.
Insulin-dependent DM.
Temp 38, pulse 108, BP 120/80.
Marked area of swelling and erythema over left shin spreading twards ankle + knee - warm/tender.
Also tender palpable lymph nodes in groin. No breaks in skin.
high WCC, CRP and BM.
You diagnose cellulitis. What other potentially dangerous condition should be considered?

A

necrotising fasciitis

42
Q

what do you feel on examining leg in necrotising fasciitis

A

crepitus [gas in tissue]

43
Q

clues + exam/Ix that a cellulitis is nec fasc?

A

disproportionate pain
systemically unwell
sweep test by plastic surgeon

44
Q

bact in nec fasc

A

group A strep

or polymicrobial

45
Q

Mx of nec fasc

A

debridement
+/- amputation
ABx - eg. clindamycin + benzylpenicillin

46
Q

24 yr old HIV +ve man. 12 day Hx of ^SOB + non-productive cough. CD4 on diagnosis 3 yrs ago was 300, no ART since.
O/E: febrile. sat 87%, falling to 72% on exertion. Examination unremarkable.
CXR - bilateral fine peri-hilar infiltrates [bat wings].
What is the likely diagnosis?

A

PCP [Pneumocystis pneumonia]

47
Q

what CD4 count is normal? and what count = AIDS?

what count do you need to have to get PCP?

A

> 500 is normal
<200 = AIDS

<200 to get PCP

48
Q

Pt has PCP. List other important HIV associated lung conditions

A

strep pneumoniae still most common!

cryptococcus, TB, CMV, pseudomonas, lung KS

49
Q

24 yr old HIV +ve man. 12 day Hx of ^SOB + non-productive cough. CD4 on diagnosis 3 yrs ago was 300, no ART since.
O/E: febrile. sats 87%, falling to 72% on exertion.
CXR - bilateral fine peri-hilar infiltrates [bat wings].
what Ix would you do to confirm a diagnosis of PCP?

A

bronchial lavage + PCR [cant get PCP from sputum]

re-do CD4

50
Q

treatment for PCP?

A

co-trimoxazole [septrin]

+pred

51
Q

in an HIV +ve patient with PCP and not on ART yet, do you give both ABx and ART together? or which would you start first?

A

TREAT INFECTIONS 1ST!

otherwise they get IRIS [Immune reconstitution inflammatory syndrome]

52
Q

What prophylaxis is used to prevent infections in HIV patients?

A

pneumococcal, HepB + flu vaccines

co-trimoxazole [septrin] if CD4 <200 [AIDS] to prevent PCP + toxoplasma

azithromycin at CD4<50 for MAI

53
Q

briefly describe a suitable ART regimen to start a patient on

A

3 drugs:
2 NRTIs [nucleoside reverse transcriptase]
and 1 from either protease inhibitors, integrase inhibitors, or NNRTI [non-nucleoside reverse transciptase]

54
Q

describe the different incubation times for hepatitis viruses A-E

A

A + E short

B,C,D long [1-6/12]

55
Q

given 2 patients, 1 a 30 yr old man born in ethiopia, the other a 30 yr old IVDU born in the UK, who is more likely to have Hep B and which Hep C?

A

hep B more likely transmitted vertically in an endemic area [or sex]

hep C more likely transmitted through injecting drugs [or anal sex]

56
Q

18 yr old woman presents with fevers + jaundice. Moved to UK aged 4 from pakistan, husband moved to UK 3 months ago just prior to their marriage.
Temp 37.8, tender RUQ, deeply jaundiced, no rash or bowel upset.
most likely cause?

A

Hep B

57
Q

if a 20 yr old contract hep B through sex, what chance do they have of clearing the virus vs chronic?

And in a child who contracted it from their mother vertically or in very early childhood?

A

age 20 - 95% clear the virus

baby - 95% go on to have chronic hep B

58
Q

18 yr old woman presents with fevers + jaundice. Moved to UK aged 4 from pakistan, husband moved to UK 3 months ago just prior to their marriage.
Temp 37.8, tender RUQ, deeply jaundiced, no rash or bowel upset.
You think she has acute hep B, how do you treat?

A

no indication for treatment for acute infection

[unless rarely fulminant - requires transplant]

59
Q

75 yr old man with know mixed mitral valve disease admitted for urinary retention secondary to BPH. Catheterised for 3 days, removed, then discharged.

2 weeks later: fever, sweats, malaise, ^SOB.
O/E: loud, harsh, systolic murmur and palpable thrill.

Diagnosis?

A

infective endocarditis from urosepsis

60
Q

clinical features of endocarditis.

A

fever, rigors, malaise
murmur
roth spots, janeway lesions, splinter haemorrhages, oslers node, clubbing, hepatosplenomegaly, arthralgia
microscopic haematuria

emboli / abscess

61
Q

who’s at risk of endocarditis?

A 
IVDU
heart murmur/ defect
prosthetic valve
Hx of rheum fever
previous IE
pacemaker/defib
HCM
62
Q

organisms for infective endocarditis

A

strep viridans
staph aureus [normal valve]
staph epidermidis [prosthetic valve]

63
Q

Ix in suspected endocarditis

A

cultures X3
echo

FBC, ESR/CRP, rheumatoid factor, U+E, Mg, LFT.
urinalysis
CXR [cardiomeg, pulm oedema]
ECG [HB]

CT [emboli in brain/spleen etc]

64
Q

how can you prevent endocarditis eg. in a pt with a catheter/ going for dental procedure who has a valve defect/ IDVU

A

amoxi prophylaxis

65
Q

which side of the heart/ valves are affected in endocarditis usually? and which in IVDUs?

A

normally L sided/ mitral

IVDU right sided/ tricuspid

66
Q

Abx of endocarditis of native vs prosthetic valve

A

4-6 weeks IV Abx based on micro consultation following cultures

e. g.
native: ampicillin, fluclox, gent
prosthetic: vanc + gent + rifampicin

67
Q

duke criteria for endocarditis - give 2 major and 2 minor criteria

A

major:
cultures
+ve echo

minor:
predisposed - IVDU/valve defect
fever
emboli/janeway lesion
glomeneph/oslers
68
Q

indications for surg in IE

A 
HF
VALVE OBSTRUCTION
repeated emboli
fungal
persistent bacetraemia
myocardial abscess
unstable infected prosthetic valve
69
Q

if strep bovis is cultured in an infective endocarditis patient, what ix should you do and why

A

colonoscopy

colon Ca is likely entry point

70
Q

complications of infective endocarditis

A 
stroke
PE
kidney infarct
abscess
HF
71
Q

hep B, C and HIV. Which is most infectious in sexual transmission

A

B

72
Q

what happens if you give amoxi in EBV

A

rash

73
Q

transmission from needle stick, which is most likely - Hep B, C or HIV?

A

Hep B

74
Q

in hepatitis serology, what does it mean if hepatitis antigens are present? [HBsAg/ HBeAg]

A

means the virus is there currently

75
Q

If you’ve been immunised to hepB, will you have surface antibodies, or core antibodies, or both?

A

surface only, meaning youve made antibodies against the surface antigen and cleared it. Surface antigen not present as the virus is not present.
No core antibodies at the vaccine doesnt contain the core of the virus.

76
Q

risk factors for developing fulminating hepatitis following viral hepatitis infection

A

imm.supp. drugs
pregnancy
HIV

77
Q

IgG and IgM. Which infers acute and which chronic?

A

IgM is acute infection

IgG is past/previous infection

78
Q

Mx of chronic hep B infection

A

tenofovir

79
Q

clinical monitoring and Mx of hepC patient

A

liver US
HCC monitoring [alpha fetoprotein]
endoscopy screen for varices
direct acting antiviral drugs

80
Q

what condition would you screen for in a TB infected patient?

A

hiv

81
Q

how do you diagnose TB

A

sputum for acid fast bacilli/ microscopy/ culture

82
Q

what do you do in a patient who you suspect has TB but culture and staining is negative?

A

not 100%, doesnt rule out TB. clinical/ radiological findings can be sufficient to treat

83
Q

risk factors for TB

A

HIV
homelessness
from endemic area

84
Q

standard TB Tx

A

isoniazid [6 months]
rifampicin [6 months]
ethambutol [1st 2 months- induction]
pyrazinamide [1st 2 months -induction]

85
Q

SEs of TB drugs

A

N+V [give antiemetics]

pyrazinamide -arthralgia
isoniazid - peripheral neuropathy [pyridoxine]
liver toxicity [Is/Rif/Py]
ethambutol - optic neuritis

86
Q

why viral load would keep going up in HIV despite ART?

A

wrong drug [mutation/resistance]
poor compliance
poor absorption [e.g. coeliac]

87
Q

how is contact screening done in TB?

A

mantoux test [if +ve, CXR etc.]

88
Q

pts with HIV at risk of what cancers

A

cervical [annual smear]
lymphoma
KS

89
Q

KS is caused by what virus

A

human herpesvirus 8

90
Q

what is meant by the “window period” in HIV

A

2-3 weeks after exposure, tests are false negative

[before host antibody response has been mounted]

91
Q

what markers can be used to assess how advanced HIV disease is/ tx monitoring

A

CD4 count

viral load

92
Q

you strongly suspect HIV in a patient, but HIV test is -ve. what do you do now?

A

re-test 12 weeks later [window period]

can do viral load/ talk to ID

93
Q

infective cause of haematuria you should test for in patient recently arrived from africa

A

schistosomiasis

94
Q

why can HIV pt get pancytopenia?

A

marrow suppression

95
Q

SEs of cotrimoxazole

A

rash [stevens johnson/TEN]

marrow suppression

96
Q

what advice do you give HIV positive new mum w/ regards feeding

A

exclusively bottle feeding

3B GH (16 decks)

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