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MRCP part 2 > Infectious disease > Flashcards

Infectious disease Flashcards

1
Q

TB meningitis CSF features

A

Cloudy
Lymphocytosis
Low glucose
High protein

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2
Q

TB meningitis treatment

A

IV rifampicn, isoniazid, pyrazinamide, dexamethasone

Avoid ethambutol due to optic complications

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3
Q

Rickettsial disease general features

A

Eschar, vasculitic rash, malaise, lymphadenopathy

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4
Q

Types of rickettsial disease

A

Americas - rocky mountain spotted fever

East asia - scrub typhus

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5
Q

Complications of rickettsial disease

A

Jaundice, meningoencephalitis, myocarditis, pneumonia and renal failure

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6
Q

Treatment of rickettsial disease

A

1) doxycycline

2) azithromycin

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7
Q

Fever frequency plasmodium vivax/ovale

A

48 hours

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8
Q

Fever frequency plasmodium malariae

A

72 hours

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9
Q

Fever frequency plasmodium falciparum

A

24 hours

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10
Q

Features of severe falciparum malaria (requires IV artesunate)

A 
schizonts on a blood film
parasitaemia > 2%
hypoglycaemia
acidosis
temperature > 39 °C
severe anaemia
complications: cerebral malaria: seizures, coma; acute renal failure: blackwater fever, secondary to intravascular haemolysis, mechanism unknown; acute respiratory distress syndrome (ARDS); hypoglycaemia; disseminated intravascular coagulation (DIC)
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11
Q

Treatment of non-severe falciparum malaria

A

artemisin-based combination therapies

e.g. artemethur + lumefantrine / artesunate + amodiaquine

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12
Q

1) Treatment of plasmodium vivax / ovale

2) why?

A

1) chloroquine / ACT (if chloroquine resistant area) + primaquine
2) primaquine for hyponozoite stage in liver - risk of relapse if not treated

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13
Q

Treatment of malaria in pregnancy

A

chloroquine

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14
Q

Treatment options in legionella pneumonia

A

1) macrolides e.g. clarithromycin, erythromycin, azithromycin
2) fluoroquinolones e.g. ciprofloxacin, levofloxacin

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15
Q

Pregnant woman with no rash but exposed to chickenpox

A

1) check VZV serology

2) if no immunity, VZV Ig - effective 10 days PEP

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16
Q

Pregnant woman with chickenpox

A

1) PO aciclovir

2) IV aciclovir & foetal medicine if severe infection

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17
Q

Bone and joint TB mx

A

Initial: RIPE 2 months
Continuing: RI 4 months

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18
Q

Mycobacterium avium Mx

A

Rifampicin, ethambutol, clarithromycin - continue until sputum -ve for 12 months

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19
Q

Leprosy mx

A

Rifampicin, clofazimine, dapsone 6-12 months

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20
Q

Staph aureus bacteraemia mx

A

2 weeks IV fluclox

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21
Q

CPE treatment

A

Polymyxins (e.g. colistin), tigecycline, fosfomycin or aminoglycosides (e.g. gent)

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22
Q

Yersinia pestis

A
  • buboes most common
  • pneumonia (person-person - active in madagascar)
  • septicaemia
    Ix: blood cultre, serology
    Mx: IV gent OR doxycycline
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23
Q

CMV colitis in HIV CD4 count

A

<50

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24
Q

African sleeping sickness parasites

A

West Africa - trypanosoma gambiense

East Africa - trypanosoma rhodesiense

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25
Q

African sleeping sickness mx

A

early: IV pentamidine

late (CNS): IV melarsoprol, suramin, eflornithine, nifurtimox

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26
Q

Chagas disease features

A

early: asymptomatic or chagoma
complications: myocarditis / dilated cardiomyopathy, megaoesophagus or megacolon

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27
Q

Chagas disease treatment

A

azoles e.g. benznidazole

heart failure management

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28
Q

Yellow fever features

A
  • viral haemorrhagic fever
  • aedes mosquito
  • flu like illness
  • period of brief remission
  • jaundice, haematemesis, renal failure, thrombocytopenia
  • hepatic inclusion bodies (councilman)
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29
Q

Strongyloides mx

A

Ivermectin OR bendazoles

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30
Q

Pinworm (pruritis ani, eggs on tape)

A

Bendazoles

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31
Q

Loa loa (loiasis)

A
  • nematode cause of filiariasis
  • Features: soft tissue swelling, eye worm, numbness in affected limb
  • Mx: diethylcarbamazine
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32
Q

River blindness

A
  • Onchocera volvulus
  • hyperpigmentation
  • blindness
  • mx: ivermectin
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33
Q

Roundworm elephantitis

A

Wuchereria bancrofti from mosquito

Mx: diethylcarbamazine

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34
Q

Schistosomiasis types

A
  • Intestinal -> pulmonary hypertension / liver cirrhosis: mansoni / intercalatum
  • urinary: haematobium - risk squamous cell carcinoma and bladder neck fibrosis
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35
Q

Schistosomiasis mx

A

Praziquantel

+ steroids if acute disease -> prevents type 3 hypersensitivity reaction

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36
Q

ESBL

A

Carbapenems e.g. meropenem

OR nitrofurantoin / fosfomycin

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37
Q

Diet after giardiasis

A

Avoid lactose 2-6 weeks

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38
Q

mycobacterium marinum

A
  • fish exposure
  • break in skin -> cutaneous lesions
  • lymphatic spread
  • doxy / cipro / clari
39
Q

Rabies mx already immunised

A

2x further vaccine doses

40
Q

Rabies mx no immunisation

A

1) touching only - nil
2) no bleeding - full immunisation
3) transdermal bite / lick broken skin - rabies Ig & full immunisation

41
Q

Typhoid Mx

A

1) Cefotaxime / ceftriaxone
2) Ciprofloxacin in certain sensitive cases
3) Azithromycin

42
Q

CMV / HHV5 treatment

A

IV ganciclovir

43
Q

Mycobacterium avium features

A
  • fever, malaise, weight loss
  • pulmonary symptoms
  • abdominal: diarrhoea, abdo pain, deranged LFTs, hepatosplenomegaly
44
Q

Mycobacterium avium treatment

A

Rifampicin/rifabutin + clarithromycin + ethambutol

- until 12 months -ve sputum

45
Q

Complications of schistosomiasis

A
  • Haematobium: urinary tract fibrosis +/- hydronephrosis, squamous cell carcinoma of the bladder
  • portal hypertension and cirrhosis
  • pulmonary hypertension
46
Q

Cutaneous larva migrans features

A

Dog / cat hookworm
Passes in their faeces -> contact with human skin
Hypersensitivity reaction in the skin but cannot get passed basement membrane or replicate - no systemic disease

47
Q

Cutaneous larva magrans mx

A

Ivermectin
OR
albendazole

48
Q

Effect of P450 inhibition on steroid treatment

A

Possible iatrogenic cushing’s

49
Q

HLA B 5701 allele positive in HIV?

A

Avoid abacavir (fatal hypersensitivity)

50
Q

Hep B post exposure prophylaxis

A

No vaccine / non-responders: hep B Ig + vaccination

Known responders: hep B vaccine 2 x booster

Incomplete vaccine: hep B Ig + accelerated course

51
Q

Hep C post exposure prophylaxis

A

NONE! 6 monthly hep C PCR +/- treatment

usually sofosbuvir combinations +/- ribavarin

52
Q

HIV post exposure prophylaxis

A
  • If undetectable viral load — very low risk, re test HIV at 8-12 weeks
  • If high risk, offer combination ART e.g. tenofovir, emtricitabine, lopinavir and ritonavir for 4 weeks — re-test at 12 weeks
53
Q

Cryptococcal meningitis features

A 
Low CD4 count
meningitic features
sub acute
raised ICP with false localising signs
seizures
CT: nil or meningeal enhancement
CSF: pleocytosis, high protein, low glucose, india ink +ve
54
Q

Cryptococcal meningitis mx

A

Amphotericin + fluconazole / flucytosine

55
Q

TB mx in HIV on protease inhibitors

A

Rifabutin, isoniazid, pyrazinamide, ethambutol

rifampicin increases ART protease inhibitor metabolism

56
Q

Leishmaniasis pathogenesis

A

Intracellular protozoan (leishmania) transmitted by sand flies can cause visceral, cutatneous and mucocutaneous patterns of disease

57
Q

Cutaneous leishmaniasis features

A
  • Leishmania tropica or Leishmania mexicana

- Crusted lesion at bite site -> ulceration

58
Q

Cutaneous leishmaniasis mx

A

May self-resolve
Cryotherapy
Topical paromycin
PO ketoconazole

59
Q

Mucocutaneous leishmaniasis features

A
  • Leishmania braziliensis
  • initial crusted skin lesions -> mucosa of nose, pharynx
  • can occur years to decades after initial infection
60
Q

Mucocutaneous leishmaniasis mx

A
  • Amphotericin B

- Miltefosine

61
Q

Visceral leishmaniasis features

A
  • Leishmania donovani
  • Mediterranean, Asia, South America, Africa
  • initial crusted lesion at bite site
  • general: fever, sweats, rigors, poor appetite, weight loss
  • abdo: massive splenomegaly, hepatomegaly
  • haem: pancytopenia secondary to hypersplenism
  • grey skin ‘kala-azar’
62
Q

Visceral leishmaniasis ix

A

DAT +ve
Bone marrow / splenic biopsy = gold standard
Can biopsy LNs

63
Q

Visceral leishmaniasis mx

A

Amphotericin B / sodium stibogluconate / fluclonazole

64
Q

Pneumocystis pneumonia prophylaxis

A

Reduced dose co-trimoxazole (septrin)
OR
Dapsone

65
Q

VZV treatment in adults

A

1) immunocompromised
- IV aciclovir if they develop chickenpox
- IVIG if VZV IgG -ve and exposed to chicken pox
2) presenting with complications e.g. pneumonitis, encephalitis - IV aciclovir

66
Q

Shingles

A
  • Immunocompetent
    < 72 hours - PO aciclovir
    > 72 hours - nil if well
    IV acyclovir if Ramsay Hunt / Herpes zoster opthalmicus if severe infection
  • Immunocompromised
    PO aciclovir if well
    IV acyclovir if disseminated / Ramsay Hunt / Herpes zoster opthalmicus
67
Q

Toxoplasma gondii mx

A

pyrimethamine + sulfadiazine

68
Q

West Nile virus

A
  • similar to japanese encephalitis virus
  • single stranded rna flavivirus
  • mosquito vector
  • most people asymptomatic
  • others can have fever +/- maculopapular rash
  • some can have CNS: meningitis, encephalitis, acute flaccid paralysis (assymetric, w/i 48 hours), axonal polyneuropathy
69
Q

Tests for syphillis

A

VDRL & RPR

  • false negatives e.g. HIV
  • becomes negative after treatment

Antibody tests e.g. treponema pallidum haemagluttination assay

  • more specific
  • remains positive after treatment
70
Q

Quickest active TB diagnostic test

A

nucleic acid amplification

71
Q

Dengue fever

A
  • aedes mosquito
  • fever
  • headache
  • myalgia
  • pleuritic pain
  • petechial rash
  • thrombocytopenia
  • raised ALT
  • may cause DIC -> viral haemorrhagic fever
72
Q

Chikingunya

A
  • ades mosquito
  • high fever
  • severe joint pain +/- joint pain
  • flu-like illness
  • transaminitis
  • similar to dengue but ++ JOINT PAIN
73
Q

Brucellosis

A
  • brucella bacteria
  • un-pasteurised milk
  • fever, malaise
  • sacroilitis, peripheral joint pain
  • hyperhydrosis
  • chronic: skin rash, hepatosplenomegaly
  • Ix: serology, rose bengal plate test
  • Mx: doxycycline + rifampicin
74
Q

Q fever

A
  • coxiella burnetii
  • source: abattoir, cattle/sheep
  • fever and malaise prodrome
  • > PUO, atypical pneumonia, endocartidits (culture -ve)
  • mx: doxycyline
75
Q

Tetanus infection mx

A
  • tetanus IVIG
  • IV metronidazole
  • wound debridement
76
Q

Trypanosomiasis ix

A
  • acute phase: peripheral blood smear

CNS features?

  • CTH / MRI -> may show oedema / white matter enhancement late in disease
  • LP: microscopy, elevated wcc, elevated IgM, elevated protein

American trypanosomiasis: serology

77
Q

Babesiosis

A
  • tick-borne protozoan infection
  • fever, chills, rigors
  • haemolytic anaemia
  • haemoglobinuria
  • reactive hypergammaglobulinaemia
  • North east USA endemic
  • less headache vs malaria, but otherwise similar
  • ix: blood smear, PCR, serology
  • mx: azithromycin + atovaquone; exchange transfusion if severe haemolytic anaemia
78
Q

Typhoid features

A
  • salmonella typhii
  • fever, malaise, headache, arthrlagia
  • abdo pain and CONSTIPATION
  • deranged LFTs, hepatosplenomegaly
  • relative bradycardia
  • rose spots
  • leukopenia
  • complications: osteomyelitis, GI bleed, myo/endocarditis, meningitis, cholecystitis
79
Q

Filiariasis

A
  • parasitic worm with mosquito as vector
    e. g. wuchereria bancrofti
  • common in rice paddy fields
  • enter lymphatics -> lymphoedema, painful lymphadenopathy
  • hypersensitivity reaction in the lungs -> tropical pulmonary eosinophilia - nocturnal wheeze, pulmonary oedema
  • general: malaise, intermittent fevers
  • Mx
    1) diethylcarbamazine
    2) ivermectin (esp if high parasitic load)
80
Q

Cysticercosis

A
  • larval stage of taenia solium (pork tapeworm)
  • neurocysticercosis -> seizures, headache, vomiting
  • extraneural SC nodules

Ix

  • CT: cystic lesions
  • fundoscopic visualisation of parasites
  • serology
  • LP is not necessary

Mx

  • anticonvulsants
  • antiparasitic: albendazole + praziquantel
    • dexamethasone to reduce inflammation with degenerating cyst
81
Q

MRSA pneumonia mx

A

Linezolid > vancomycin

82
Q

Chlamydia infection

A

Ix: NAAT of urine and swab
Mx: 7 day doxy or single dose azithromycin

83
Q

Gonorrhoea infection

A
  • urethral swab NAAT

- IM ceftriaxone (specific to gonorrhoea) + azithromycin (chlamydia cover)

84
Q

Severe malaria features

A
  • GCS <11
  • acidosis
  • lactate >5
  • hypoglycaemia
  • parasitaemia >10%
  • shock
  • GI bleeding
  • pulmonary oedema
  • jaundice
  • creat >265
  • severe anaemia
85
Q

Malaria prophylaxis

A 
- chloroquine
OR atovaquone + proguanil
OR mefloquine
OR doxycycline
- take until 7 days after return
- most resistance with falciparum
86
Q

Cat scratch disease

A
  • bartonella henselae (G-ve rod)
  • fever, regional lymphadenopathy, malaise, headache
  • preceding papular lesion

Complications

  • neuroretinitis - visual loss
  • abdo pain / hepatosplenomegaly
  • encephalopathy / transverse myelitis
  • MSK

Ix:

  • serology
  • MCS
  • LN biopsy
  • PCR

Mx: azithromycin

87
Q

When to give steroids in addition to co-trimoxazole for PCP pneumonia

A

PaO2 <9.3

88
Q

Leptospirosis

A
  • leptospira interogans
  • sewage workers, farmers, vets (must come into contact with rat urine)
  • fever, flu-like, headache
  • renal failure 50%
  • jaundice w/ RUQ tenderness but NO hepatosplenomegaly
  • meningitis may occur
    Mx: benzylpenicillin / doxycycline / cephalopsorins
89
Q

Parvovirus B19 related red cell aplasia: association, blood film, mx

A
  • associated with HIV
  • anaemia without reticulocytes
    Mx: IVIG
90
Q

Mx of meningiococcal meningitis if severe penicillin allergy

A

Chloramphenicol

91
Q

Mx of S Aureus endocarditis if penicillin allergic

A

Vancomycin + rifampicin

92
Q

Vaccines to avoid in HIV+ve patients

A 
Live attenuated
- BCG
- intranasal influenza
- typhoid
- oral polio
- cholera
(- yellow fever -> consider if CD4 >200)
(- varicella -> consider if CD4 >200)
(- MMR -> consider if CD4 >200)

Decreased efficacy

  • hep a/b combo
  • hep a / typhoid combo
93
Q

BD glucan

A

Found in fungi including p. jiroveci

94
Q

Galactomannan

A

Found in aspergillus

MRCP part 2 (11 decks)

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