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MRCP Part 1 > Infectious diseases > Flashcards

Infectious diseases Flashcards

1
Q

What is the incubation period for syphillis?

A

9 - 90 days

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2
Q

What are the features of primary syphillis?

A

Chancre at the site of sexual contact (in women may be on the cervix)
Local non tender lymphadenopathy

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3
Q

What are the features of secondary syphillis?

A

Secondary features occur 6 - 10 weeks after initial infection.

  • Fever, lymphadenopathy
  • Rask on trunk, palms and soles, buccal ulcers, painless warty lesions on the genitals
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4
Q

What are the features of tertiary syphillis?

A

Gummas (granulomatous lesions of the skin and bones)
Ascending aortic aneurymss
Paralysis
Argyll robertson pupil

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5
Q

What are the features of congenital syphillis?

A

Hutchinsons teeth
Keratitis
Saddle nose
Deafness

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6
Q

What is the treatment for leptospirosis?

A

High dose benzylpenicillin or doxycycline

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7
Q

What investigations are required for leptospirosis?

A

Serology
PCR
Culture (limited in usefullness)

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8
Q

What is leptospirosis?

A

An infection caused by a spirochate leptospira interrigans which is spread by infected rat urine.

The early phase is fever, flu like sympoms and subconjuntival suffusions

The secondary phase in called weils disease and you get an AKI, hepatitis and aseptic meningitis

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9
Q

What is the treatment for legionalla pneumonia?

A

Erythromycin/clarithromycin

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10
Q

What might the blood tests show in legionalle pneumonia?

A

Hyponatremia

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11
Q

What antibiotic is used to treat cutaneious anthraz?

A

Ciprofloxacin

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12
Q

What kind of bacteria is anthraz?

A

Bacillus anthacis is a gram positive rod

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13
Q

What is the diagnostic test for crytosporidium?

A

Moodified zieh neelsen staining of the stool (reveals the red cysts of cryposporidium)

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14
Q

What is the treatment for leprosy?

A

Rifampicin, dapsone and clofazimine

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15
Q

What are the main features of leprosy?

A

Patches of hypopigmented skin on the buttocks face and extensor surface of the limbs

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16
Q

What is the definition of chronic hepatitis C?

A

Persistence of HCV is the blood for 6 months

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17
Q

What percentage of people will clear hepatitis C on their own?

A

15 - 45% will clear the virus after an acute infection

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18
Q

What is the treatment for chronic hepatitis C?

A

Protease inhibitors (daclatasvir + sofosbuvir ) with out without ribavirin

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19
Q

What opportunisitc infections is a patient with HIV likely to get if there CD4 count is 200 - 500?

A

oral thrush
Shingles
Hairy leukoplakia
Kaposi sarcoma

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20
Q

What opportunisitc infections is a patient with HIV likely to get if there CD4 count is 100 - 200?

A 
Cryptosoridiosis 
Cerebral toxoplasmosis 
Progressive multifocal leukoencephalopathy (secondary to the JC virus)
PCP pneumonia 
HIV dementia
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21
Q

What opportunisitc infections is a patient with HIV likely to get if there CD4 count is 50 - 100?

A

Aspergillosis
Oesophageal candididis
Cryptococcal meningitis
Primary CNS lymphoma

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22
Q

What opportunisitc infections is a patient with HIV likely to get if there CD4 count less than 50?

A

CMV retinitis

Mycobacterium avium intracellular infection

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23
Q

When does the p24 antigen become positive in HIV?

A

1 - 4 weeks after infection

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24
Q

When do most people develop antibodies to HIV?

A

4 - 6 weeks but 99%% of people have antibodies by 3 months

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25
Q

What test should you do if you think someone has HIV seroconversion?

A

P24 antigen. (Antibodies can take 3 months to develop)

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26
Q

What tests do you do if you suspect malaria?

A 
Rapid diagnosit tests such as QBC are most specific for the detection of falciparum malaria
Blood films (thick and thin) Thick looks for the parasite and thin confirms the  species
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27
Q

What is the treatment for uncomplicated malaria?

A

Oral artemisinin combination therapy (eg riamet which is artemether-lumefantanrine)

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28
Q

What is the treatment of severe or complicated malaria?

A

IV artesunate (15% of patients need haemodyalysis)

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29
Q

What does cerebral toxoplasmosis look like on a CT scan?

A

Single or multiple ring enhancing lesions

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30
Q

What is the management of cerebral toxoplasmosis?

A

Pyrimethamine plus sulphadiazine for at least 6 weeks

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31
Q

What are the features of congenital toxoplasmosis?

A 
Neurological damage 
- Cerebral calcification, hydrocephalus, chorioretinitis
Opthalmic damage 
- Retinopathy 
- Catarcsts
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32
Q

What is the mechanism of action of aciclovir?

A

DNA polymerase inhibitor - prevents further viral DNA synthesis without affecting normal cellular processes

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33
Q

What kind of virus is HIV?

A

RNA reterovirus

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34
Q

What is the difference between HIV1 and HIV 2

A

HIV 1: Most common type in US and worldwide

HIV 2: Seen in Western Africa and Southern Asia. It appears to be less pathogenic and has a slower progressions to AIDS

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35
Q

What cells does HIV target?

A

CD4 cells (this includes dendritic cells, T helper cells and macrophages)

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36
Q

What co receptors does HIV use to get into the cell?

A

CXCR4 - found on T cells

CCR5 - found on t cells, macrophages and dendritic cells.

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37
Q

What virus causes kaposi sarcoma?

A

Human herpes virus 8

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38
Q

How long should you wait before getting pregnant if you have recently been in a zika virus zone?

A

6 months

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39
Q

What virus causes genital herpes?

A

HSV 2

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40
Q

What are the features of severe malaria?

A 
Schizonts on blood film 
Parisitaemia of over 2% 
Hypoglycaemia 
Acidosis 
Temperature over 39
Severe anaemia
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41
Q

What are the complication of severe malaria?

A

Cerebral malaria - seizures, coma
Acute renal failure (blackwater fever which is secondary to intravascular haemolysis)
Acute respiratory distress syndrome
DIC

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42
Q

What is chagas disease?

A

A parastic disease common in central and south america caused by the protozoan trypansoma cruzi. It is transferred though insect faeces (reduvid bug).

It has an incubation period of around 2 weeks

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43
Q

What are the symptoms of acute chagas disease

A

Chagoma (tissue damage and local inflammation of the bite site 0 eye or skin, usually on face)

Meningoencephalitis

Myocarditis
, Heart block and pericardial effusion

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44
Q

What is the most dangerous complication of chronic chagas disease?

A

Cardiomyopathy

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45
Q

How do you diagnose chagas disease?

A

Acute:
Blood film
T Cruzi DNA
Chronic: Serology

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46
Q

What is the treatment for chagas disease?

A

Anti parasitic medication eg benznidazole or nifurtimox

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47
Q

What vrus causes genital warts?

A

HPV (usually 6 and 11)

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48
Q

What is the treatment for tape worms?

A

Albendazole

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49
Q

What bacteria causes erysipelas?

A

Strep pyogenes

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50
Q

What virus is primary CNS lymphoma associated with in HIV patients?

A

Epstein barr virus

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51
Q

What is the treatment for schistosomiatis?

A

Praziquantel

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52
Q

How is leishmaniasis transmitted?

A

Caused by Spread by sandflies

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53
Q

What test remains positive after treatment for syphillis?

A

Treponema pallidum haemagglutinatioj test (TPHA)

54
Q

What test will be negative after treatment for syphillis?

A

VDRL

55
Q

What vaccines should people with no spleen have?

A

pneumococcal, haemophilus type B and meningococcal type C (administered 2 weeks prior to splenectomy)

56
Q

What is the most common type of non falciparum malaria?

A

Plasmodium vivax

57
Q

Why are patients with malaria ovale or vivax given primaquine following acute treatment with chloroquine?

A

To destroy liver hypnozoites and prevent relapse

58
Q

What is the treatment for active TB?

A 
2 months of:
Rifampicin
Isoniazid 
Pyrazinamide 
Ethambutol
Then 4 months of rifampicin and isoniazid
59
Q

What is the treatment for latent TB?

A

3 months of isoniazid with pyridoxine and rifampicin
OR
6 months of isoniazid

60
Q

What is chikungunya virus?

A

An alphavirus caused by infected mosquitos. Seen in africa, asia and india mostly.

61
Q

What are the symptoms of chikungunya virus?

A

Prominent symptoms are severe joint pain and abrupt onset of high fever.

62
Q

What test can you do to confirm a diagnosis of lyme disease?

A

ELISA antibodies to borrelia burgdorferi

63
Q

What is the treatment for diptheria?

A

IM penicillin

Diptheria antitoxin

64
Q

At what CD4 count do patients need prophylaxis against PCP?

A

Less than 200

65
Q

What kind of bacteria is salmonella?

A

Aerobic gram negative rods

66
Q

What does botulinum toxin do?

A

Inhibits the release of acetylcholine at the synapses of the nervous system (peripherally and centrally)

67
Q

What kind of bacteria is neisseria meningitides?

A

Gram negative cocci

68
Q

List 5 gram positive bacilli?

A 
Actinomyces 
Bacillus anthracis 
Clostridium
Diptheria 
Listeria
69
Q

List 6 gram negative bacilli?

A 
E coli 
Haemophilus influenzae 
Pseudomonas aerruginosa 
Salmonella 
Shigella
Campylobacter
70
Q

What are the three stages of lymphogranuloma venereum ?

A
  1. Small painless pustule which later forms an ulcer
  2. Painful inguinal lymphadenopathy
  3. Proctocolitis
71
Q

What is the treatment for cerebral toxoplasmosis?

A

Pyrimethamine plus sulphadiazine

72
Q

What is strongyloides stercoralis?

A

A human parasitic nematode worm. The larvae are present in soil and gain access to the body by penetrating the skin.
Features include diarrhoea, abdominal pain, lesions on the feet and buttocks, rash

73
Q

What is the treatment for strongyloides stercoralis infection?

A

Ivermectin

Albendazole

74
Q

When do you give steroids in PCP pneumonia?

A

If hypoxic (p02 below 9.3)

75
Q

What causes chancroid?

A

Haemophilus dicreyi

76
Q

What is the most common organism isolated after a dog bite?

A

Pasturella multocida

77
Q

What is the treatment for amoebic dysentary?

A

Metronidazole

78
Q

What is african trypanosomiasis?

A

Sleeping sickness. A protozoal disease spread by the tetse fly. There are two types. An acute (rhodesiense)and chronic (gambiense).

79
Q

What are the symptoms of african trypansomiasis?

A

Chancre at the point of infection
Intermittent fever
Enlargement of posterior cervical lymph nodes
CNS involvement - somnolence, headaches, mood changes, menigoencephalitis

80
Q

What is the treatment for african trypansomiasis?

A

Early disease: IV pentamidine

Later disease: IV melarsoprol

81
Q

What are the most common causes of viral meningitis?

A 
Enteroviruses (eg coxsackie) 
Mumps
Echovirus 
Herpes simplex 
Cytomegalobirus 
Herpes Zoster Virus 
HIV 
Measles 
Influenza
82
Q

What is katayama fever?

A

The acute form of schistosomiasis which presents with fever, myalgia, cough, diarrhoea, urticarial rash and hepatosplenomegaly.
Eosiniophillia is seen on the bloods

83
Q

Which anti TB medication can cause drug induced lupus?

A

Isoniazid

84
Q

How does dengue fever present?

A

Found in South America

  • Sudden onset fever and athralgia
  • (low platelets and haemmorhage in the case of dengue haemmorhagic fever)
85
Q

What is the treatment for dengue fever?

A

Symptomatic only

86
Q

What are the 5 types of malaria?

A 
Plasmodium falciparum 
Plasmodium Vivax
Plasmodium malariae
Plasmodium ovale 
Plasmodium knowlesi
87
Q

Which types of malaria have a long gap between infection and disease symptoms?

A

Plasmodium vivax and plasmodium ovale

88
Q

How often do the fevers occue in plasmodium malariae malaria?

A

every 72 hours

89
Q

How often do the fevers occue in plasmodium vivax and ovale malaria?

A

48 hours

90
Q

How often do the fevers occue in plasmodium knowlesi malaria?

A

24 hours

91
Q

How often do the fevers occue in plasmodium falciparum malaria?

A

Varies - usually every 24 - 48 hours

92
Q

Which subtypes of malaria are most likely to relapse? Why?

A

Ovale and vivax - They have a hypnozoite stage and this means they are dormant in the liver

93
Q

What tretment should people with malaria vivax or ovale be given following acute treatment to destroy liver hypnozoites and prevent relapse?

A

Primaquine

94
Q

What condition is a contraindication to primaquine treatment?

A

G6PD deficiency (risk of haemolysis)

95
Q

What is the treatment of a wound in someone who has had all tetanus vaccines within the last 10 years?

A

No vaccine or immunoglobulin regardless of wound severity

96
Q

What is the treatment of a wound in someone who has had all tetanus vaccines but the last dose was over 10 years ago?

A

If tetanus prone wound - further vaccine

High risk wound - vaccine + immunoglobulin

97
Q

What is the treatment of a wound in someone who has an unknown tetanus vaccine status?

A

Reinforcing dose of vaccine regardless of severity

Vaccine + Immunoglobulin for tetanus prone and high risk wounds

98
Q

What are the names of fusion inhibitor drugs?

A

Enfuvirtide

Paraviroc

99
Q

What are the names of protease inhibitor drugs?

A

All end in navir:

Indinavir, Atazanavir

100
Q

What are the names of integrase inhibitor drugs?

A

All have tegra in them:
Raltegravir
Elvitegravir

101
Q

What are the nams of NNRTIs?

A

Have vir in the middle of them:
Delavirdine
Efavirenz

102
Q

What does antireteroviral therapy involve?

A

A combination of at least 3 drugs: usually two nucleoside reverse transcriptase inhibitors + a protease inhibitor or an NNRTI

103
Q

Name some nucleoside analogue reverse transcriptase inhibitors?

A

Zidovudine,

abacavir, tenofovir

104
Q

What is a general side effect of NRTIs?

A

Peripheral neuropathy

105
Q

What do fusion inhibitors do?

A

Stop HIV from binding to and entering cells.

106
Q

What do NRTIs do?

A

Decoy nuceloside which makes it impossible for HIV to attach another nucleoside which prevents the DNA chain forming.

107
Q

What do NNRTIs do?

A

Stop the nucleoside chain by attaching to the end of reverse transcriptase

108
Q

What do integrase inhibitors do?

A

Stops integrase from bringing viral DNA into the nucleus

109
Q

What do protease inhibitors do?

A

Stops cleavage/transcription of proteins from HIV cells.

110
Q

What is mycobacterium avium complex?

A

An atypical mycobacterial infection seen in HIV patients. Seen when the CD4 count is less than 50 cells/mm3

111
Q

What prophylaxis can be given against mycobacterium avium complex?

A

Clarithromycin or azithromycin when the CD4 count is less than 100

112
Q

What is the treatment of mycobacterium avium complex?

A

Rifampicin + Ethambutol + Clarithrmomycin

113
Q

What are the symptoms of rabies?

A

Prodrome - headache, fever, agitation
Hydrophobia
Hypersalivation

114
Q

What are the symptoms of strongyloides stercoralis infection?

A

Rash on the soles of feet and buttocks, abdominal pain, diarrhoea

115
Q

What is the treatment of strongyloides stercoralis infection?

A

Ivermectin

Albendazole

116
Q

What treatment is given for chronic hepatitis B?

A

Peg interferon alpha

117
Q

Which antireteroviral drugs inhibit the p450 system?

A

Protease inhibitors

118
Q

Which antireteroviral drugs induce the p450 system?

A

Nevirapine (NNRTI)

119
Q

What is the treatment of diptheria?

A

IM penicillin

Diptheria antitoxin

120
Q

What cardiac manifestation can diptheria have?

A

Heart block

121
Q

List the live attenauted vaccines?

A 
BCG
MMR 
Intranasal influenza
Oral rotavirus 
Oral polio 
Yellow fever 
Oral typhoid
122
Q

What is the treatment of mycoplasma pneumonia?

A

Doxycycline or a macrolide (erythromycin/clarithromycin)

123
Q

What antibiotics are given from prophylaxis of meningococcal meningitis?

A

Ciprofloxacin and rifampicin

124
Q

What antiretroviral therapy should be given to the neonate of a mother with HIV?

A

Zidovudine orally if the maternal load is less than 50 copies.
Otherwise triple ART for 4 - 6 weeks

125
Q

How should mothers with HIV deliver?

A

Viral load less than 50 copies at 36 weeks - Vaginal

Otherwise C section (zidovudine infusion 4 hours prior)

126
Q

At what CD4 count should patients with HIV receive PCP prophylaxis?

A

Less than 200

127
Q

What is the chance of hepatitis B being transmitted during a single needlestick injury?

A

20 - 30%

128
Q

What is the chance of hepatitis C being transmitted during a single needlestick injury?

A

0.5 - 2%

129
Q

What is the chance of HIV being transmitted during a single needlestick injury?

A

0.3%

130
Q

What are the features of japanese encephalitis?

A

Headache, fever, seizures, confusion

Parkinsonian symptoms

131
Q

What is lemierre’s syndrome?

A

Infectious thrombophlebitis of the internal jugular vein - occurs secondary to a bacterial sore throat caused by fusobacterium necrophorum leading to a to a peritonsillar abscess. Risk of septic pulmonary emboli

MRCP Part 1 (30 decks)

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