Infectious disease/ skin Flashcards
Common cx pneumonia in alcoholics
Klibsielal
Pneumonia with influenza predispsoses to?
Staphj aureus pneumonia
flu-like symptoms, bilateral consolidation and erythema multiforme, painful vesicles in ear, renal impairment, low platelets
Mycoplasma - to serology. TX: doxycycline/ erythromycine/ clindamycin
Derranged LFts, flu like SX, cough, bradycardia, lymphopenia, confusion low sodium
Legionella - erythromycin/ clarithromycin. confirm urinary antigen
fishy smell’ down below. Microscopy reveals the presence of clue cells.
Gardnerella vaginalis - 5 days metronidazole 400mg BD
fever, malaise, and myalgia, which may precede the appearance of painful vesicular eruptions in the genital area.
Herpes Simplex
Campylobacter enteritis TX
Clarithromycin
Salmonella/ shigella TX
Ciprofloxacin
Pelvic inflammatory disease TX
Oral ofloxacin + oral metronidazole or intramuscular ceftriaxone + oral doxycycline + oral metronidazole
Animal or human bite TX abx
Co-amox (allergy - doxy and metronidazole)
Mastitis during breast feeding?
Fluclox
Meningitis tx summary: if
meningoccocal?
if <3m or 50+
if listeria suspected?
when to start dexamethasone?
What to give contacts?
when to delay LP?
what could suggest cryptococcal meningitis?
IV cefotaxime, if <3 months or 50+ add amoxicillin (or ampicillin).
If meningococcal - ben pen or cefotaxime.
listeria give IV amoxicillin and gent.
IV dex before abx, avoid in septic shock, in sus pneumococcal meningitis in adults
contact: Oral ciprofloxacin or rifampicin for 7 days
delay LP: GCS<12, focal neuro sx, papilloaedema, seizures continued
cryptococal meng - high opening pressure LP, sex worker, AIDS, yeast and capsule in CSF stained with india ink
Painless genital ulcers causes?
Syphilis (single) - Treponema pallidum.
Lymphogranuloma venereum (LGV) - cuased by chlamydia, tx doxycycline.
donovanosis (granuloma inguinal)
multiple - HPV warts
Unilateral, painful inguinal lymph node enlargement. with single painful genital ulcer? sharp, jagged border
Chancroid - Haemophilus ducreyi (painful, patients do cry)
Tetanus vaccine uk?
2, 3, 4 months
3-5 yrs,
13-18 yrs
Cellulitis TX
flucloxacillin,
allergy - macrolide such as clarithromycin or erythromycin or another medication such as doxycycline.
UTI TX in pregnancy women
tx asap 7 days first-line: nitrofurantoin (should be avoided near term)
second-line: amoxicillin or cefalexin
trimethoprim is teratogenic in the first trimester and should be avoided during pregnancy
GE with short intubation period and severe vomitting no diarrhoea
Staphylococcus aureus
GE incubation period of 3-4 days and causes diarrhoea that usually becomes bloody, lasting up to a week.
E-coli
48-72 hrs GE A flu-like prodrome, crampy abdominal pains, fever and diarrhoea which may be bloody
May mimic appendicitis
Complications include Guillain-Barre syndrome
Campylobacter - tx clarithromycin
HIV patient, hepatospenlomegaly, pneumonia signs, clear chest. cx?
tx?
Pneumocystitis jiroveci. Need broncheolar lavage, TX co-trimoxazole. Risk pneumothorax. need proph abx if cd4 <200.
tx: co-trimoxazole. consider steroids if hypoxic
lymes disease progression? early (in 30 days. late?
and tx?
first line test?
early: erythema migrans 1-4 weeks after, painless, malaise, arthralgia.
later: heart block, peri/myocarditis. :neurological:
facial nerve palsy,radicular pain,meningitis.
TX:
doxycycline / amoxicillin - in pregnancy/allergy as doxy is CI./ if disseminated - ceftriaxone
IX: ELISA antibody to borrelia burgdorferi. if neg and still sus, do in 4-6 weeks after
Flu sx, raised, red painful rash on legs and face?
erysipelas- Flucloxacillin* (clarithromycin, erythromycin or doxycycline if penicillin-allergic)
ID cx: difficulty in breathing and swallowing. A grey coating surrounding the tonsils, fever, and cervical lymphadenopathy, travel to india
Diptheria - can present with cranial nerve sydfunction. IM penicillin
pneumonia cx: worsening flu-like symptoms and a dry cough. Erythema multiforme is noted on examination. Infective changes on CXR
Mycoplasma pneumoninae
URTI SX, given amoxicillin then got rash? DX? lymphadenopathy, raised ALT,
EBV/ glandular fever. do monospot test, do FBC and LFT (lymphocytosis, raised ALT, haemolytic anaemia)
Fishy discharge, clue cells. allergic to penicillin
Metronidazole if not allergic/
topical clindamycin for BV
Cellulitis - abx for pregnant and pen allergy?
pregnant - erythromycin
Pen allergy - clarithromycin
Syphillis stages?
6-10 weeks after?
tx?
painless chancre on penis, local painless LN, men / or lesion on cervix
6-10 weeks: fevers, LN, snail track buccal ulcers, condulomata lata (painless warty lesions on genitalia, rash on trunk and arms
risks: aortic aneurysms, gummas, tabes dosalis - neuro issues/ bladder issues/ muscle wasting, argyll-robertson pupil
Normal: IM benzathine penicillin
or doxyclycine (not in pregnancy)
Common reaction - fever, tachy, fever no wheeze. (jarisch herxheimer reaction)
Non-bloody diarrhoea, fatty stools, 15 days after exposure, bloating, flatulent
Giardiasis is caused by the flagellate protozoan Giardia lamblia. Swimming anal sex etc. chronic - risk of low vitamins, malnoutrition
purple papules or plaques on the skin or mucosa (e.g. gastrointestinal and respiratory tract)
Kaposi’s sarcoma - radiotherapy/ resection. Caused by HHV 8.
malaise,headache and mild abdominal pain. Constipation, bloated, sparse, macular rash on chest. CX of GE?
what are other complications?
common risk in sickle cell disease?
Salmonella typhi - enteric fever (constipation and rose spots), low HR
risks: osteomyelitis (esp sickle cell), GIB, meng, cholecystitis,
single painless ulcer with small lymphadenopathy/ then 2 months later widespread maculopapular rash and ulcers in mouth, systemic features
Stages of syphillis, trepenoma pallidum.
t2DM on SGLT2 - dapagliflozin, painful and numb to touch in perineum, purple rash with bullae
Necrotising fascitis / fournier’s gangrene (in perineum)
other type - t1DM post op
what are the live vaccines? (MY BOOTI)
MMR, yellow fever, BCG, ORal polio, oral rotavirus, typhoid, intranasal influenza
Tx for toxoplasmosis in immunocompromised ppl?
Pyrimethamine and sulphadiazine are management options for immunocompromised patients. complications: chorioretiinits, seziures, anaemia
multiple painful blisters and ulcers around her labia. She has been feeling like she has the flu for the past five days. It is extremely painful when she urinates.
Herpes simplex
oral ulcers, genital ulcers and uveitis. Venous thromboembolism is also seen.
Small cell vasculitis, behcet’s
Chlamydia treatment? pregnant ?
Doxycycline 7 days, if pregnancy - erythromycin, azithromycin,
Dry cough, target lesions around trunk, works in school?
CXR?
Mycoplasma pneumoniae (erythema multiforme)
CXR: reticulo nodular shadowing of right lung
URTI in CF, hot tub folliculutus, otitis externa in diabetics, UTIs.
Pseudomonas aeruginosa
EBV associated malignancies?
Burkitt’s lymphoma*
Hodgkin’s lymphoma
nasopharyngeal carcinoma
HIV-associated central nervous system lymphomas
non tender LN with cats at home, unwell, fever, sore throat? How does neuro manifestation of this condition present?
toxoplasmosis:
in HIV aids - most common is neuropsych/ hemiperesis/speech abdnormality
dysentry, no sx, liver mass from recent travel?
AMoebiasis
tx - metronidazole, uss
urticarial rash on body swimming in thialand lake, very unwell generally, myalgia ?
shistosomiasis
malaria detected by
giesma stained thicka nd thin blood films
typhoid fever characteristics?
7-14 post ingestion
fever worsens over day and gets better by morning
1st week: GI sx, truncal blanching/ inflamed peyers patches and maculopapules
week2: splenomegaly, brady cardia
week3: abdo distension, pea soup diarrhoea, nectroic peyers pathces lead to perforation/ peritonitis
IX: bone marrow culture
face flushing, chills, skin mottling before fever on 3rd day lasting 5-7 days. children get fever that gets better for 1 day then returns. bleeding from gums/ melena/ haemorrhagic effects
Dengue fever cx aedes mosquitos
need serology
raised antibody titre in apired IGG/ IGM
low patelets, leukopenia
also: abdo pain, hypotension, restlessness,
aplastic anaemia?
marrow criteria and film critera?
cx?
bone marrow failure with peripheral pancytopenia, marrow hypoplasia (marrow criteria)
film criteria:
neutrophil <0.9, platelet <20
reticulocyte <1%
bimodal age distribution
cx: autoimmune, infections, anti drugs (abx, anti cancer, antiepileptic, antithyroid, antiemetic, anticancer, antihyperglycaemics
SX: bleeding, anaemia, infections
allergic contact dermatitis and tubercilin tests example of?
Type 4 sens. lymphocytes, secondary cellular response
erythema nodosum is an example of what type of hypersensitivity?
type 3: immune complexes, activate complement and cause local damage
Causes of haemolytic anaemia/ features?
jaundice, anaemia, splenomegaly
Autoimmune - warm (IGG, cold IGM
Microangiopathic haemolytic anaemia - DIC, ITP, TTP,
inherited: G6pd (x linked
21YO, genetic disorder. changed diet recently - has ataxia/ collapsing attacks after rash on face, arms and legs, becomes anxious/ emotional/ aggressive?
hartnup syndrome (AR).
attacks normally happen from 3-9YO. this is rare. need high protein diet.
is AO and AB parent have children could they be blood gorup o/
no absence of A/B give O group. AB can donate to anyone
explain blood group donation?
a can donate to AB and A
B can donate to AB and B
O can donate to anyone
AB can receive from anyone but only donate to AB
O can donate to anyone
what is sideroblastic anaemia ?
body produces iron but is not able to put into HB. iron accumulation in the mitochondria of erythoid precursors
ESR in sickle cell?
low bc unable to form rouleax
post splenectomy, what infections ar eu most likely to get?
Shin Skis
what vaccines do you get?
spleen protects against encapsulated microbes
SHIN SKIs
step pneumoniae
h influenzae
neisseria meng
Group B strept
klibsiella
salmonella tphyi
vaccines:hib, pneumococcl, meningococcal, annual flu
Likelihood of getting down’s syndrome?
20/ 30/ 40/ 35/ 40/ 45?
20:1/1500,
30:1/800,
35: 1/270
40: 1/100
45: 1/50+
Child recurrent sinusitis, chronic diarrhoea, URTI, / has reactions to IVG / transfusions?
selective immunoglobulin IGA deficiency
classic malaria symptom re fever?
fever paroxysm: suddenly cold, with rigor then fever and sweating
when does rash appear for lyme disease?
Cx?
TX?
7 days post bite, unwell, fever, neuro sx.
CX: borrelia burgdorferi
TX: doxycycline 14-21 days (CI pregnancy)/ amox then cefuroxime
<12 YO: amoxicillin then cefuroxime
undiagnosed neuro condition is CI to which vaccine?
MMR
25YO hiv+, diarrhoea, ziehl neelson cysts on stool sample
cryptosporidiosis
what is passive and active immunity?
passive - provide IGG., short lived
active - acquired/ natural exposing body to antigen to respond
erythematous, well demarcated warm plaque sharp border 6cm upper arm, malaise, fever 48 hours. skin biopsy: beta-haemolytic group A streptococcal infection in the upper dermis.
abx tx?
ersyipelas - flucloxacillin
farmer, high fever, sweating. several black blisters which produce foul smelling discharge. cx organism?
clostridium perfringens - can cause gas gangrene and haemolysis
infection from canned foods and honey
prevents acetylcholine (ACh) release leading to flaccid paralysis
clostridium boutilism
Impetigo abx tx?
topical hydrogen peroxide/ orial fluclox or erythromycin if widespread
GE causes: sudden vomiting and non blood D, with short intubation period?
similar to above but presents in children < 5
N+V cramp like pain, bloody D, longer intubation 3-4 days, abdominal crmaping??
sudeen GE - norovirus. resolve within 72 hs
child <5 - rotavirus
3-4 day intubation epriod = ecoli
appendicitis like: cambylobnacter. tx clarithromycin
B/G chlamydia with RUQ pain, low grade fever. negative pregnancy test, negative KUB and urine dip neg.
Fitx-hugh curtis (perihepatitis) caused by chlamydia, PID
complications of chlamydia?
IX/DX
epididymitis
pelvic inflammatory disease
endometritis
ectopic pregnancies
infertility
reactive arthritis
perihepatitis (Fitz-Hugh-Curtis syndrome)
IX: women - vulvovaginal swba first line
men - urine. 2 weeks after exposure
TX: doxycycline 7 days. if CI - azithromycin
pregnanct: azithromycin/ erythromucin/ amox
sore throat, fever, LN anterier and posterior neck. bruises in mouth, raised ALT, haemolytic anaemia. tried amoxicillin for URTI but got rash? cx?
AF/ other sx?
when to sx resolve?
DX?
glandular fever - EBV/HHV4
AF: splenomegaly, palatal petechiae, rash after pencillin, haemolytic anaemia (cold agglutin IMG), rash after penicllin. low socioeconomic status
sx go in 2-4 weeks
DX: monospot (heterophil antibody)
hx of sickle cell disease, low platelets, HB, WBC (all cell lines), recent febrile illness. now has petechiae and bruises over trunk and limbs.
DX?
aplastic slaptastic crisis?
parvovirus b19 - pancytopenia - also causes slapped cheek
Jarisch herxheimer reaction seen in?
this is fever, rash after first abx dose.
syphillis, lymes, glandular fever
Exposure to hep C tx?
do monthly PCR, if seroconversaion give interferon+- ribavirin
Person with incomplete course of hep B vaccine is exposed to a positive hep B patient, how do we treat?
if we don’t know the exposed blood was hep b positive?
not responder if anti-HBs <10 in 1-2 months post immunization.
give hep B IG and booster vaccine.
if unknown source - give vaccine / accelerated vaccine
Person immune to hep b already and a responder exposed to patient with Hep B positive?
what if unknown exposure?
give booster or consider giving booster if unknown source
post exposure HIV tx?
oral antiretrovirals within 1-2 hrs, but could be started up to 72 hrs after for 4 weeks. do testing at 12 weeks after completion
most common cx of bronchiectasis exacerbations/ acute epiglottitis/ CAP?
Haemophilus influenzae
cx of penumonia - erythema multiforme, normocytic anaemia?
mycoplasma pneumoniae
UTI tx men/ pregnant? non pregnant?
when to send urine culture?
when to give prophylaxis
nitro/trim 3 days.
do MSU in 65+/ visable/ non visable haematura/ men
tx in asymptomatic pregnany women
pregnant/ men/ catheter - 7 days.
farmer with initial mild flu like sx red eyes.
then unwell with AKI. cx?
DX?
tx?
leptospirosis
first subconjivical haemorrhages, flue. then aKI/ hepatitis/ asceptic meningitis
DX?- serology (antibodies after 7 days), PCR, CSF
leptospirosis tx: doxy/ azithromycin then IV benpen if severe
Complications of hep B?
immunisation of hep B schedule?
how to test for hep b repsonse?
chronic hep, HCC, GN, polyateritis nodosa, crytpoglobulinaemia
child - 2,3,4 months, occupational workers
test for occupation exposure: do anti HBs. is 100+ - adequate response. give booster in 5 yrs
10 -100 - sub-optimal response, give another dose. no testing needed
<10- test for past infection/ give 3 doses again. no response then consider HB1G
BV - pathogen?
Amsel’s criteria for dx?
tx?
risks if BV in pregnancy?
how does trichomonas rpesent?
gardngerella vaginalis
amsel’s - 3+ of thin white discharge, clue cells, ph 4.5+, positive whiff
tx: metronidazole if sx 5-7 days/ 2g metronidazole if adherence issue. topical clindamycin.
pregnany risks: chorioamniotis, late miscarriage, LBW, preterm labour
TV: frothy, yellow green, vulvovagintis, strawberry cervic, motile trophozoites
common cx of infection in animal bites?
strepococci spp, staph A, eikenella, fusobacterium, prevotella
Which antimalarial should be avoided in someone with hx of depression/ epilepsy and taken weekly?
which one is photosensitive?
which should be given with folate supplementation
mefloquine (mental health)
photosens - doxycylcine
folate with proguanil
cx of coup/ bronchiolitis
common cold cx?
pneumonia cx likely in smokers?
IECOPD most common cx?
croup - parainfluenza, bronch - RSV
cold - rhinovirus
smoker’s pneumonia - streptococcus pneumoniae
IECOPD - haemophilus influenzae
Cellultiis tx? if pen allergy? if pregnant?
when to consider admitting?
fluclox,
po clarithromycin ( if allergy). erythromycin if pregnant
eron class 3-4 (sepsis/ systemic upset or co-morbilities, vasc compromise, lymphedema, facial cellulitis, frail or <1yr
HBsAG positive how long what does it mean?
Anti hbs?. anti hbc?
HBsAg - acute disease (present for 1-6 months)
> 6 months then this implies chronic disease (i.e. Infective)
Anti-HBs immunity/ exposure. negative in chronic disease
Anti-HBc previous (or current) infection. IgM anti-HBc appears during acute or recent hepatitis B infection and is present for about 6 months
HbeAg - infectivity
risks of chronic hep C (6 months)
rheumatoid, sojrens, cirrhosis, HCC, cryoglobulinaemia, porphyria cutanea tarda
memranoproliferatvie GN
Tetanus when to give booster/ ig?
what is clean wound
clean:Wounds less than 6 hours old, non-penetrating with negligible tissue damage
if 10yrs +/ unknown/ not vaccinated - give booster regardless. if high risk/ tetanus prone - give IG
Complications of mycoplasma penumonia?
haemoyltic anaemia (igM)
erythema multiforme, erythema nodosum
GBS, bullous myringitis (painful vesicles on Tympanic membrane)
GI - hep/pancreatitis
acute GN
young man, painful blisters and ulcers on penis, unprotected sex. dysuria and pruritus. malaise dx? tx?
mx in pregnancy?
genital herpes. aciclovir. HSV1 and 2
genital warts - HPV 6 and 11
recurrent eps less severe. other first sx: inguinal LN, urine retention
DX: NAAT. HSV serology if unknown cause of ulcer
pregnant - if 28weeks+, C-s. if recurrent, suppressive therapy
Sx of metronidazole with alcohol?
disulfiram like reaction - head and neck flushing, N+V, sweating, headache, palpatations
Tx of genital warts?
HPV 6+ 11
topical podophyllum (for multiple non keratinised)/ cyrotherapy (single keratinised)
imiquimod topical (2nd line)
before giving BCG vaccine, what to test?
tuberculin test in anyone over 6YO who have had no contact with TB.
CI: HIV, pregnancy, positive tuberculin, past TB,
HIV DX tests and screening.
when would you test in asymptomatic patients? if negative and still sus?
p24 antigen (1-4 week) and HIV antibody (4-6 weeks after infection positive).
no sx: do 4 weeks after possible exposure. if negative, repeat test at 12 weeks
Worker in africa, incidental CXR of 2cm calcified nodule in mid right zone, non smoker.
TB latent - ghon complex
TX: RI - 3 months (I+P) or 6 months ISOniazid +Pyridoxine
