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MSRA > Infectious Disease/ Immunology > Flashcards

Infectious Disease/ Immunology Flashcards

1
Q

Pasteurella multocida is the most common bacteria from what?

A

Majority of animal bites are from cats and dogs.

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2
Q

Animal bites + human bites

Mx (2)

A
  1. Clean wound - nil need for suturing unless cometic concerns
  2. Coamox/ doxy+metro if pen allergic
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3
Q

Typical chest infection mx
Pen allergy
If suspected staph what do you give?

Atypical chest mx

HAP mx (2)
<5 days
> 5 days

A

Chest
Amoxicillin
Pen allergy = doxy or clarithro
Add fluclox if suspected Staph –> e.g influenza

Atypical chest
Clarithro

HAP
<5 days coamox/ cefuroxime
>5 days taz/ cephalasporin

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4
Q

Quinolone example

A

Ciprofloxacin

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5
Q

Pyleo abx

Prostatitis abx

A

Cephalosporin/ quinolone

Quinolone/ trimethroprim

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6
Q

Impetigo (3)

A
  1. Topical hydrogen peroxide
  2. fusidic acid
  3. fluclox/ erythro if widespread
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7
Q 
Abx choice
Throat infection 
Sinusitis
Otitis media 
Otitis externa
Periapical or periodontal abscess
Gingivitis
A 
Phenoxymethylpenicillin
Phenoxymethylpenicillin
Amoxicillin 
Fluclox
Amoxicillin
Metronidazole
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8
Q 
Abx choice
Gonnorrhea 
Chlamydia
PID
Syphillis
BV
A

Abx choice
IM ceftriaxone
Doxy/ azithro
Ofloxacin + metro OR IM ceftriaxone + doxy + metro
Benzathine benzylpenicillin or doxy or erythro
Metro

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9
Q 
C diff
First presentation 
Second presentation 
Campylo 
Salmonella 
Shigellosis
A 
C diff
Metro
Vanc
Clarithro 
Cipro
Cipro
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10
Q

A flu-like prodrome is usually followed by crampy abdominal pains, fever and diarrhoea which may be bloody
May mimic appendicitis
Complications include Guillain-Barre syndrome

A

Campylo

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11
Q

Two types of illness are seen
vomiting within 6 hours, stereotypically due to rice
diarrhoeal illness occurring after 6 hours

A

Bacillus cereus

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12
Q

Gradual onset bloody diarrhoea, abdominal pain and tenderness which may last for several weeks

A

Amoebiasis

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13
Q

Severe vomiting

Short incubation period

A

Staph Aureus

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14
Q

Bloody diarrhoea

Vomiting and abdominal pain

A

Shigella

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15
Q

Profuse, watery diarrhoea
Severe dehydration resulting in weight loss
Not common amongst travellers

A

Cholera

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16
Q

Prolonged, non-bloody diarrhoea

A

Giardiasis

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17
Q

Common amongst travellers
Watery stools
Abdominal cramps and nausea

A

E coli

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18
Q 
Legionella 
Where is it from?
Features (5)
Dx (1) 
Mx (2)
A 
Air conditioning 
1. Flu like illness
2. Hyponatraemia
3. Abnormal LFTs
4. Dry cough 
5. Pleural effusion 30% of pts 
Dx urinary antigen 
Mx 
Erythro/ clarithro
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19
Q 
Infectious mononucleosis
AKA 
Triad of sx
Features (3) 
Dx
A 
EBV
Human herpes 4 (HHV 4) 
1. Sore throat
2. Lymphadenopathy 
3. Pyrexia

Features

  1. Splenomegaly - risk of splenic rupture, nil contact sports for 8 weeks
  2. Hepatitis - transient rise in ALT
  3. Haemolytic anaemia secondary to cold agglutins (IgM)

Dx
1. FBC and Monospot (heterophil antibody test) in 2nd week of illness

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20
Q

Cause of central line infections
Coagulase positive or negative?

Staph Aureua - coag positive or negative?

A

Staph Epidermis

  • Coagulase-negative
  • Cause of central line infections and infective endocarditis

Staph Aureus

  • Coagulase-positive
  • Causes skin infections (e.g. cellulitis), abscesses, osteomyelitis, toxic shock syndrome
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21
Q

Fine maculopapular rash on face spreading down body

Suboccipital lymphadenopathy

A

Rubella

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22
Q

HSV-1
HSV-2
Primary infection presentation
Rx

A 
Oral ulcers 
Genital ulcers
Gingivostomatitis
Rx acyclovir 
If an outbreak >K28 then for CS
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23
Q 
Syphillis 
Caused by which organism 
Primary features (2)
Secondary features (3) 
Tertiary features (4)
A

Treponema pallidum
Primary
- painless ulcer - chancre
- local non-tender lymphadenopathy

Secondary

  • fevers, lymphadenopathy
  • rash on trunk, palms and soles
  • buccal ‘snail track’ ulcers (30%)
  • condylomata lata (painless, warty lesions on the genitalia )

Tertiary

  • gummas (granulomatous lesions of the skin and bones)
  • ascending aortic aneurysms
  • general paralysis of the insane
  • tabes dorsalis
  • Argyll-Robertson pupil
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24
Q

Bronchiolitis

A

Respiratory syncytial virus

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25
Q

Croup

A

Parainfluenza virus

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26
Q

Common cold

A

Rhinovirus

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27
Q

Flu

A

Influenza virus

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28
Q

The most common cause of community-acquired pneumonia

A

Streptococcus pneumoniae

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29
Q

Community-acquired pneumonia
Most common cause of bronchiectasis exacerbations
Acute epiglottitis

A

Haemophilus influenzae

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30
Q

Pneumonia, particularly following influenza

A

Staphylococcus aureus

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31
Q

Atypical pneumonia

Flu-like symptoms classically precede a dry cough. Complications include haemolytic anaemia and erythema multiforme

A

Mycoplasma pneumoniae

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32
Q

Atypical pneumonia

Classically spread by air-conditioning systems, causes dry cough. Lymphopenia, deranged liver function tests and hyponatraemia may be seen

A

Legionella pneumophilia

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33
Q

Common cause of pneumonia in HIV patients. Typically patients have few chest signs and develop exertional dyspnoea

A

Pneumocystis jiroveci

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34
Q

A wide range of presentations from asymptomatic to disseminated disease are possible. Cough, night sweats and weight loss may be seen

A

Mycobacterium tuberculosis

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35
Q

Mx Meningitis caused by Listeria

A

Intravenous amoxicillin + gentamicin

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36
Q

Meningococcal meningitis

A

Intravenous benzylpenicillin or cefotaxime

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37
Q

Mx meningitis pen allergic

What medication should be given if meningitis other than abx?

A

Chloramphenicol

Dexamethasone

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38
Q

Mx of contacts of meningitis

A

Everyone who has been in close contact/ respiratory secretion exposure should be offered prophylaxis in the 7/7 prior to onset of symptoms + offer meningococcal vaccination

Ciprofloxacin

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39
Q

Kaposi’s sarcoma is caused by?

What is it?

A

HHV-8

Purple papules or plaques on the skin or mucosa (e.g. gastrointestinal and respiratory tract)

40
Q

small papule which develops into a larger annular lesion with central clearing, ‘bulls-eye’ AKA erythema migrans = which condition?

A

Lyme disease

41
Q

Pharyngitis, grey-white membrane on pharynx
bulky cervical lymphadenopathy
‘bull neck’ appearance

42
Q

Diphtheria is caused by which organism?
Gram +ve/ -ve
Mx

A

Gram positive bacterium Corynebacterium diphtheriae

intramuscular penicillin
diphtheria antitoxin

43
Q 
Lyme disease
Early features (1) 
Late features (2)
A
  1. Bulls eye lesion AKA erythema migrans
  2. CN palsy
  3. Myocarditis/ polyarthritis/ meningitis
44
Q

EBV associated conditions:

A
  1. Burkitt’s lymphoma
  2. Hodgkin’s lymphoma
  3. nasopharyngeal carcinoma
  4. HIV-associated central nervous system lymphomas
  5. Hairy leukoplakia
45
Q

Helicobacter pylori

Associated with which cancer?

A

B cell lymphoma of MALT tissue

46
Q

A 35-year-old man who has recently emigrated to the country presents with back pain associated with night sweats. He has also lost 5kg in weight over the past month is a stereotypical history of:

A

Pott’s disease

Tuberculosis spondylitis - TB in the spine

47
Q 
BV findings (5)
Bacteria 
pH
Discharge smell 
Discharge colour 
Microscopy 
Mx (3)
A 
Gardnerella vaginalis
Raised pH ( > 4.5 )
Fishy discharge
Thin white discharge 
Clue cells

Mx PO metro/ topical metronidazole or topical clindamycin

48
Q

Gram +ve

Gram -ve staining

A

Purple

Pink

49
Q 
Anaphylaxis doses of adrenaline, hydrocort, chloram
<6 months 
6 months - 6 years
6-12 years
Adult and child > 12 years
A 
150 mcg (0.15ml 1 in 1,000)	25 mg	250 mcg/kg
150 mcg 0.15ml 1 in 1,000)	50 mg	2.5 mg
300 mcg (0.3ml 1 in 1,000)	100 mg	5 mg
500 mcg (0.5ml 1 in 1,000)	200 mg	10 mg
50
Q 
Which hepatitis is spread by the faecal-oral route?
Which are RNA and DNA?
Significant mortality in which?
Which has vaccines?
Which has risk of HCC
Which requires another to propogate?
A 
Hep A+ E 
All RNA except Hep B = DNA 
Significant mortality in Hep E
A+B have vaccines
B+C = risk of HCC
Hep D requires Hep B to propogate
51
Q

a 5-year-old develops fever, pharyngitis and conjunctivitis = ?

A

adenovirus

52
Q

Gonorrhea caused by?
Gram +ve or negative?
Mx

A

Gram-negative diplococcus Neisseria gonorrhoeae
IM ceftriaxone
If sensitive to cipro to give single dose

53
Q

Most common cause of septic arthritis in young adults

A

Gonoccocal

54
Q

Aminoglycosides adverse effects (2)

A

Nephrotoxicity, Ototoxicity

55
Q

Which abx commonly causes c diff?

A

Clindamycin

56
Q

Chloramphenicol adverse effect?

A

Aplastic anaemia

57
Q 
Name the condition
1. Parotitis
2. Orchitis
3. Hearing loss (ear ache also)
Notifiable disease
58
Q

Live attenuated vaccines (7)

A
  1. BCG
  2. measles, mumps, rubella (MMR)
  3. influenza (intranasal)
  4. oral rotavirus
  5. oral polio
  6. yellow fever
  7. oral typhoid
59
Q 
CSF analysis Bacterial
Appearance
Glucose
Protein 
White cells
A 
Analysis
Cloudy 
Low 
High 
5000
60
Q 
CSF analysis Viral
Appearance
Glucose
Protein 
White cells
A 
Analysis
Cloudy/ clear
High (60-80% of plasma glucose) 
Normal/ raised
1000
61
Q 
CSF analysis TB
Appearance
Glucose
Protein 
White cells
A

Slight cloudy/ fibrin web
Low
High
300

62
Q 
CSF analysis Fungal
Appearance
Glucose
Protein 
White cells
A

Cloudy
Low
High
200

63
Q

Non-gonococcal urethritis
Most common organisms (2)
Rx

A

Chlamydia
Mycoplasma genitalium
Rx doxy / azithro

64
Q

First line mx for UTI in pregnant women
Secondline mx
Which abx is teratogenic?

A
  1. Nitro (unless near term)
  2. Amoxi or cefalexin
    Trimethoprim in 1st trimester
65
Q

Symptomatic UTI in catheterised pt:
Abx length of time
Asymptomatic bacteria in catheterised pt mx

A 
7 days (usually trimeth)
Nil abx
66
Q

Mx Active TB

A

First 2 months

  1. Rimfampacin
  2. Isoniazid
  3. Pyranzinomide
  4. Ethambutol

Next four months

  1. Rifampicin
  2. Isoniazid

RIPE RI

67
Q

Trypanosomiasis
Type of disease
Types (2)
How is it spread?

Mx of both types

A

Protozoal
African Trypanosomiasis (sleeping sickness)
American Trypanosomiasis (Chaga’s disease)
Tsetse fly

African Mx early disease: IV pentamidine or suramin
America Mx: azole

68
Q

Trimeth adverse effect

A

Myelosuppression

69
Q

TV
Discharge colour
O/E
pH

A

vaginal discharge: offensive, yellow/green, frothy
vulvovaginitis
strawberry cervix
pH > 4.5

70
Q

multiple ring-enhancing lesions =
mx
Seen in which condition?

A

Toxoplasmosis
pyrimethamine plus sulphadiazine for at least 6 weeks
HIC

71
Q

Fungal nail infections Mx

A

Terbinafine

72
Q

Rose-red rash makes the cheeks appear bright red
Rash can spread but does not affect palms/ soles

x4 names for the disease

Mx

A 
Fifth disease 
Parvovirus B19 
Erythema infectiosum
Slapped cheek 
Mx self limiting
73
Q

Haemophilus ducreyi
painful genital ulcers
unilateral, painful inguinal lymph node enlargement
ulcers sharply defined, ragged, undermined border.

74
Q

Trimethoprim and co-trimoxazole should be avoided in patients taking which medication?

75
Q

Type of allergy test for contact dermatitis

A

Skin patch

76
Q

Type of allergy test
Most commonly used
Useful for food allergies and also pollen

A

Skin prick

77
Q

Type of allergy test
Useful for food allergies, inhaled allergens (e.g. Pollen) and wasp/bee venom

Blood tests may be used when skin prick tests are not suitable, for example if there is extensive eczema or if the patient is taking antihistamines

A

Radioallergosorbent test (RAST

78
Q

Small (2 - 5 mm) fleshy protuberances which are slightly pigmented, can bleed or itch = what is it? what is it caused by?
Mx (2)

A

Genital warts usually caused by HPV 6&11

  1. topical podophyllum or cryotherapy
  2. imiquimod
79
Q

Tetanus

When to treat

A

Patient has had full course of vaccines, with the last dose < 10 years ago = nil treatment needed

> 10 years ago
if tetanus prone wound: reinforcing dos
high-risk wounds reinforcing dose of vaccine + tetanus immunoglobulin

If vaccination history is incomplete or unknown
reinforcing dose of vaccine, regardless of the wound severity
for tetanus prone and high-risk wounds: reinforcing dose of vaccine + tetanus immunoglobulin

80
Q
  1. grey, pseudomembrane on the posterior pharyngeal wall
  2. bulky cervical lymphadenopathy
    = which condition
    Mx
A

diptheria

Mx penicillin IM, diptheria anti-toxin

81
Q

Campylobacter jejuni
Gram +ve/-ve
Complications
Rx

A 
Gram-negative bacillus 
Guillain-Barre 
Reiter's syndrome
septicaemia, endocarditis, arthritis
Rx clarithro
82
Q

How should a patient be screened for MRSA?

A

nasal swab and skin lesions or wounds

83
Q

Suppression of MRSA from a carrier once identified

A

nose: mupirocin 2% in white soft paraffin, tds for 5 days
skin: chlorhexidine gluconate, od for 5 days. Apply all over but particularly to the axilla, groin and perineum

84
Q

MSRA Mx (2)

A

vancomycin

teicoplanin

85
Q

What is the most important advice you should give a pt regarding the side effect of metronidazole?
Inhibitor/ inducer?

A

Do not take + drink alcohol

Inhibitor

86
Q

Rabies can cause?

Mx

A

Acute encephalitis

  1. Wash wound
  2. If pt already immunised then to give x2 further doses
  3. If not already immunised then HRIG should be given with vaccination. Dose to be given around the site of wound.
87
Q

How often can adrenaline be repeated in anaphylaxis?

A

Every 5 minutes

88
Q

Chlamydia Rx

Contact tracing

A

doxycycline (7 day course) first-line
if pregnant then azithromycin
for men with urethral symptoms: all contacts since, and in the four weeks prior to, the onset of symptoms
for women and asymptomatic men all partners from the last six months

89
Q

First line treatment of non disseminated Lyme disease

Disseminated

A

14 day course of oral doxycycline

Ceftriaxone

90
Q

Giardiasis mx

91
Q 
Bloody diarrhoea (3) 
Short incubation periods (2) 
Persistent diarrhoea (2)
A

Shigella, campylo, amoebiasis
Bacillus + Staph
Giardiasis + amoebiasis

92
Q

CF + chest infection = which bacteria

Which type of bacteria (-ve/+ve)

A

Pseudomonas aeruginosa
Gram-negative rod
non-lactose fermenting
oxidase positive

93
Q

prevents acetylcholine (ACh) release leading to flaccid paralysis

A

C. botulinum

94
Q

Commonest protozoal cause of diarrhoea?

Common in which group of pts?

A

Cryptosporidiosis

Immunocompromised e.g HIV + young children

95
Q

Gram-negative rod
non-lactose fermenting
oxidase positive
=

A

Pseudomonas aeruginosa

96
Q

stool: modified Ziehl-Neelsen stain (acid-fast stain) characteristic red cysts found in which organism?

A

Cryptosporidium

97
Q

positive whiff test = ?

MSRA (22 decks)

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