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Infectious Diseases Flashcards

1
Q

Hep A is an RNA virus, how is it spread? What is the incubation period?

A

Faecal - Oral spread or by shellfish

Incubation period is 2-6 weeks

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2
Q

Name four risk factors for Hepatitis

A

Personal contact
IVDU
MSM
Health workers

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3
Q

Give 5 symptoms of Hepatitis A

A 
Nausea
Malaise
Arthralgia
Jaundice
Pale Stools/Dark Urine
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4
Q

What investigations would you do for Hepatitis A, and what would they show?

A

Immunoglobulins (raised IgG for acute infection)
LFTs (ALT raised, potential damage to synthetic function)
USS to exclude other diagnoses

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5
Q

How is Hepatitis A managed?

A 
Supportive
Avoid alcohol
Vaccine available (works for one year or twenty with booster)
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6
Q

Hep B is a DNA virus, how is it spread? What is it’s incubation period?

A

Spread by blood products, sexual contact or vertically

Incubation is 1-6 months

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7
Q

Give 6 symptoms of Hep B

A 
Nausea
Malaise
Arthralgia
Urticaria
Jaundice
RUQ Ache
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8
Q

Describe the following Hep B Serology: HbsAg, HbeAg, Antibodies to core antigen, Antibodies to surface antigen

A

HbsAg - present 1-6 months after exposure (if persists past 6 months then it is chronic)
HbeAg - present 1.5-3 months after exposure (implies high infectivity)
Antibodies to core antigen imply past infection
Antibodies to surface antigen imply vaccination

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9
Q

Describe the management of Hep B

A

Supportive
Immunise sexual contacts
Any signs of chronic liver inflammation - 48/52 of retrovirals such as Peginterferon Alfa-2a

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10
Q

State two complications of Hep B

A

Cirrhosis

Hepatocellular Carcinoma

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11
Q

Hep C is a RNA virus, how is it spread? What is its incubation period?

A

Spread is via IVDU, Blood Transfusions and Sexual

Incubation is 6-9 weeks

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12
Q

How would acute Hep C present?

A

Often asymptomatic, may just be jaundiced

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13
Q

How would chronic Hep C present?

A

Over 80% of cases are chronic

Malaise, Weakness, Anorexia

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14
Q

Name three possible investigations for Hep C

A

LFTs
PCR of the virus to confirm ongoing infectivity
If PCR +ve then do a liver biopsy to assess damage

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15
Q

Describe the management of Hep C

A

Stop alcohol/smoking
Start anti-virals
NO VACCINE AVAILABLE

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16
Q

What is Hep D?

A

A co - infection for Hep B (as it is an incomplete RNA virus)

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17
Q

How would you investigate Hep D?

A

You would test for Anti Hep B antibody, and then if that was positive, proceed to do the Anti Hep D antibody

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18
Q

How would you manage Hep D?

A

Peginterferon Alfa-2a has limited success so a liver transplant may be required

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19
Q

Describe three features of Hep E’s pathophysiology/epidemiology

A

RNA virus similar to Hep A
Common in Indochina
Associated with pigs

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20
Q

Describe the pathophysiology of Meningitis

A

Inflammation of the leptomeninges (arachnoid and pia) by virus/bacteria/non infective causes

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21
Q

Give four risk factors for Meningitis

A

Young Age
Immunosupression
Crowding
Spinal Procedures

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22
Q

Name the causative organisms of bacterial meningitis in neonates

A

Group B Strep

E.Coli

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23
Q

Name the causative organisms of bacterial meningitis in adults

A

Haemophilus Influenza
Strep Pneumoniae
Neisseria Meningitidis

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24
Q

Name the causative organisms of bacterial meningitis in the elderly

A

Strep Pneumoniae

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25
What is Aseptic Meningitis? Give 4 examples
When no bacteria can be cultured | Viral Infections, Fungal Infections, TB, Partially treated meningitis
26
Give 4 causes of non infective Meningitis
Malignant Cells (Leukaemias, Lymphomas) Medication (NSAIDs, Trimethoprim) Sarcoidosis SLE
27
Give 5 symptoms of Meningitis
``` Fever Nausea Headache Nuchal Rigidity Photophobia ```
28
What are some differentials for Meningitis?
Intracranial Abscess SAH Encephalitis
29
What investigations should be performed if Meningitis is suspected?
``` Immediate Lumbar Puncture (pre abx) FBC, CRP Blood Culture ABG Coagulation Screen EEG (if seizing) ```
30
Describe the management of viral Meningitis
Supportive | IV Aciclovir if Herpes Simplex Virus is suspected
31
Describe the management of bacterial Meningitis
Supportive | IV Ceftriaxone AND Dexamethasone
32
Give 3 complications of Meningitis
Cerebral Oedema SIADH Waterhouse Friderichson Syndrome
33
What is Cellulitis?
Infection of the dermis and deep subcutaneous tissue with poorly demarcated borders Likely due to Streptococcus Pyogenes or Staphylococcus Aureus
34
Give 4 risk factors for Cellulitis
Previous Cellulitis Venous Insufficiency Alcoholism IVDU
35
How would Cellulitis present?
Usually unilateral and in lower limb May have an area of damaged skin Localised Erythema/Pain/Swelling May have systemic symptoms
36
State 4 investigations you could do for suspected Cellulitis
Skin Swab CRP Fine Needle Aspirate Culture
37
Give 3 features of a Cellulitis Management plan
Supportive (Rest, Elevation, Analgesia) Flucloxacillin 500mg QTS (or Erythromycin if pen allergic) Emollient to keep skin hydrated
38
Describe the pathophysiology of Malaria
Parasite infection from Plasmodium species of Mosquito (female only) Most common is Falciparum followed by Vivax and Ovale Sporozoites travel to the liver and become Merozoites
39
Give 4 clinical presentations of Malaria
High Fevers Malaise Headache Myalgia
40
Name 2 signs OE of Malaria
Jaundice | Hepatosplenomegaly
41
Give three diagnostic techniques for Malaria
Microscopy Rapid Diagnostic Test of Parasite Antigen LFTS
42
How would you treat Malaria (P.Vivax and P.Ovale)?
Chloroquine | Primaquine (prevention of relapse - test for G6PDH first)
43
How would you treat Malaria (P.Falciparum)?
Oral Quinine Sulphate and Doxycycline
44
Give 3 risk factors for Gastroenteritis
Poor Personal Hygiene Immunocompromised Achlorhydria
45
What are the incubation periods of different Gastroenteritis infectants?
Viral - a day Bacteria - Few hours to 4 days Parasites - 7-10 days
46
Diagnosis of Gastroenteritis is normally clinical, but what investigations could you do?
Stool - Microscopy, Culture and Staining Blood Tests Imaging (if bowel distension)
47
What is the management of Gastroenteritis?
Supportive | Anti- Motility if required (eg Loperamide)
48
What is Osteomyelitis?
Infection of the bone marrow which can affect the cortex and periosteum (necrosis) via spread through Haversian Canals.
49
What are the most common pathogens causing Osteomyelitis?
Staphylococcus Aureus (most common) Haemophilus Influenza Escherichia Coli
50
Give four risk factors for Osteomyelitis
Trauma, Diabetes, IVDU, Peripheral Arterial Disease
51
How would Osteomyelitis of a long bone present?
Acutely febrile, Painful immobile limb
52
How would Osteomyelitis of vertebrae present?
Back pain worse at rest Localised Oedema Localised tenderness
53
What is Potts Disease? How would it present?
Osteomyelitis of the vertebrae, specifically as a result of TB Causes vertebral body collapse, and abscess formation
54
What investigations would you do for suspected Osteomyelitis? What would they show?
FBC - Elevated white cells and inflammatory markers Blood culture/bone culture MRI - Bone marrow oedema
55
How would you manage acute osteomyelitis?
Extensive surgical cleaning | Flucloxacillin for 4-6 weeks
56
How would you manage chronic osteomyelitis?
Extensive surgical cleaning | Antibiotics for 3-6 months
57
Describe the pathophysiology of Infective Endocarditis in 3 steps
1) Turbulent flow damages endothelium 2) Platelets and fibrin adhere to give non bacterial thrombotic endocarditis 3) Circulating bacteria adhere to vegetation on the valves
58
What are the common causative organisms of Infective Endocarditis
Usually Strep Viridans Staph Aureus in IVDU May be fungal in immunocompromised/IVDU
59
Give three risk factors for Infective Endocarditis
Skin Breaches Immunocompromised Valvular Disease
60
Give 3 symptoms of Infective Endocarditis
Fevers Rigors Night Sweats
61
Give 3 signs of Infective Endocarditis
Splinter Haemorrhages Janeway Lesions New/Modified Cardiac Murmurs (usually Aortic Regurg)
62
A common complication of Infective Endocarditis is the formation of an Aortic Root Abscess, how would this present?
Prolonged PR Interval AV block Left Ventricular Failure
63
What investigations would you do for suspected Infective Endocarditis?
Trans-Oesophageal Echocardiography Blood Cultures ECG CXR
64
How would you manage Infective Endocardtis?
Initial empirical treatment with Amoxicillin and Gentamicin while awaiting sensitivity results Surgery indicated if heart failure or valvular obstruction
65
How is Typhoid fever transmitted? What is it's incubation period?
Transmission is faecal-oral | Incubation is 6-30 days
66
Give 4 symptoms of Typhoid Fever
Fever Malaise Anorexia Dry cough
67
Give 3 signs characteristic of Typhoid Fever
Faget's Sign (Bradycardia and Fever) Rose Spots Hepatosplenomegaly
68
Give 3 investigations for Typhoid Fever
FBC Blood Culture Stool Culture
69
How would you manage Typhoid Fever?
Avoid Abx until diagnosis is confirmed | Azithromycine (1g PO on the first day, then 500mg daily after)
70
Define Pyrexia of Unknown Origin
Temperature more than 38 degrees on more than one occasion Illness>3 weeks duration No diagnosis despite 1 weeks worth of inpatient
71
Categories of causes of PUO include Infective/Autoimmune/Neoplastic and Other. Give 2 examples of each.
Infective - TB, Brucellosis (slow growing) Autoimmune - Temporal Arteritis, Wegener's Granulomatosis Neoplastic - Leukaemia, Lymphoma Other - Thromboembolism, Hyperthyroidism
72
What percentage of the population does C.Diff harmlessly colonate?
2-5%
73
What investigations would you do for C.Diff?
Stool tests (PCR for C.Diff proteins, ELISA for C.Diff toxins)
74
How would you manage mild and severe C.Diff respectively?
Stop causative antibiotic if possible Mild - 400mg Metronidazole every 8 hours Severe - 500mg Vancomycin every 6 hours (ideally PR due to better enteral penetration)
75
Give two complications of C.Diff
``` Toxic Megacolon (requiring urgent colectomy) Multi System Organ Failure ```
76
What is MRSA resistant to?
Beta Lactams
77
What percentage of the population is nasally colonised with MRSA?
20-30%
78
What investigation is carried out for suspected MRSA?
PCR for mecA gene
79
What is the management of an MRSA skin/soft tissue infection?
Incision and drainage | Tetracycline + Rifampicin OR Clindamycin
80
What is the management of a resp MRSA infection?
Tetracycline or Clindamycin
81
What is conjunctival suffusion? What is it caused by?
Reddening of the conjunctiva | Leptospirosis
82
Give 5 causes of splenomegaly
``` Malaria Leishmaniasis Typhoid Brucellosis EBV ```
83
Describe the pathophysiology of HIV in four steps
1) HIV binds to CD4 receptors on T cells 2) HIV uses reverse transcriptase to bind to host DNA 3) DNA replication 4) Causes inflammation and spreads to other tissues
84
How is HIV transmitted
Via bodily fluids
85
Give 5 symptoms of primary HIV
``` Flu like Maculopapular Rash Myalgia Lymphadenopathy Weight Loss ```
86
Describe the 5 stages of HIV in terms of CD4
``` Primary - Normal CD4 Stage 1 - >500 CD4 Stage 2 - <500 CD4 Stage 3 - <350 CD4 Stage 4 - <200 CD4 (AIDs Defining) ```
87
Give 3 investigations for HIV
ELISA for HIV antigen and antibody Rapid Immuno- Assay Kit Nucleic Acid Testing (for viral RNA)
88
State 5 Opportunistic diseases seen in HIV
``` PCP Pneumonia Candidiasis Cryptococcus Neoformans causing Meningitis Kaposi's Sarcoma Lymphoma ```
89
Name the four targets of HIV anti retrovirals
``` Inhibiting viral entry Inhibiting reverse transcriptase Inhibiting viral integration Inhibiting protease (viral maturation) ```
90
How is TB spread?
Aerosol inhalation causing pulmonary infection and subsequent haematogenous spread
91
What is the Quantiferon test?
Assesses the amount of interferon gamma released from T cells when exposed to mycobacterium CANNOT differentiate between active and latent
92
What is the T Spot test?
Same principle as Quantiferon test but tests an individual T lymphocyte (good for immunosupressed patients)
93
How is latent TB treated?
Not treated if over 35 usually (high risk of hepatotoxicity) | 3 months Rifampicin and Isoniazid OR 6 months Isoniazis
94
Give 4 symptoms of active TB
Non resolving cough Weight loss Night sweats Haemoptysis
95
Describe 3 features seen on a TB XRay
Mediastinal lymphadenopathy Cavitating Pneumonia Pleural Effusion
96
What would be seen on a CT scan of TB?
Lymphadenopathy (often with central necrosis)
97
How would you aim to take a biopsy from a suspected pulmonary TB patient?
FIrst try a sputum sample If the sputum sample is negative then proceed to bronchoscopy/EBUS to take sample from pulmonary lymph nodes (caseating granulomatous inflammation)
98
What would you see on the lumbar puncture of meningeal TB?
Inreased lymphocytes HIGH protein Low glucose
99
What is the paradoxical reaction in TB?
As bacteria die there is an increase in inflammation causing worsening symptoms Steroids are initiated if this is in a place where an increase in inflammation would not be tolerable (eg CNS)
100
Describe the treatment plan for Active TB
2 months of Rifampicin/Isoniazid/Pyrazinamide/Ethabutol along with Pyridoxine 4 months of Rifampicin/Isoniazid plus Pyridoxine
101
Name 2 side effects of Rifampicin
Orange Urine | Drug induced hepatitis
102
Name 3 side effects of Isoniazid
Peripheral Neuropathy (vit B deficiency) Colour Blindness Drug induced hepatitis
103
Name a side effect of Pyrazinamide
Drug induced hepatitis
104
Name a side effect of Ethambutol
Reduced visual acuity
105
Give three features of infection control in TB
Contact tracing Nursed in a side room until they've had atleast two weeks of treatment Wear a mask if giving aerosol treatment such as nebuliser
106
What subtypes of Human Herpes Viruses are involved in Herpes Simplex Virus?
Human Herpes 1 & 2
107
Describe the pathophysiology of Herpes Simplex Virus
Viruses multiply in epithelial cells on skins surface producing vesicles/ulcers Can enter sensory neurones and remain latent
108
Describe how primary Herpes Simplex VIrus would present
May have a prodrome of tingling along the sensory nerve Vesicles/Shallows ulcers (healing in 8-12d) Fever Malaise Lymphadenopathy
109
How would reactivation of Herpes Simplex Virus present?
Usually less severe than primary infection
110
What is Gingivostomatitis? How would it present?
Herpes infection of oral mucosa and gums | Fever, Sore throat, Tender oropharyngeal vesicles
111
How is active Herpes Simplex Virus treated?
Aciclovir (IV route if encephalitis)
112
How is VZV (HHV 3) transmitted? What is its incubation period?
Respiratory droplet infection | 14-21d
113
Describe the pathophysiology of VZV
Infects respiratory mucosa Multiplies in lymph nodes Disseminates via mononuclear cells to skin epithelia Can lay dormant in root of sensory nerve
114
How might chickenpox present?
May have a prodrome of fever/malaise/headache | Pruritic rash with vesicles that crust in 48h
115
What is the infectious period of chickenpox?
Infectious 1-2 days before lesions appear, and 5d after lesions have scabbed over
116
How would Shingles present?
Painful hyperaesthetic area | Vesicular rash in dermatomal region
117
Name two complications of Shingles
Post Herpetetic Neuralgia | Ramsey Hunt Syndrome
118
You only investigate VZV if the patient is immunocompromsied, what technique would you use?
Viral PCR
119
VZV is only treated in adults, how would you manage it?
Adults - Oral Aciclovir/Valaciclovir within 48h of rash | Immunocompromised/Pregnant - IV Aciclovir
120
What is a VZV vaccination?
Vaccination against Shingles given to over 70s
121
Describe the pathophysiology of EBV (HHV4)
Virus targetting circulating B lymphocytes and squamous epithelia of oropharynx
122
There are two ways in which EBV can present, describe them
Asymptomatic (normally in childhood) | Infectious Mononucleosis
123
What are the signs/symptoms of Infectious Mononucleosis?
``` Sore Throat Fever Anorexia Lymphadenopathy (especially in post.triangle) Hepatosplenomegaly Jaundice ```
124
What would a blood film of EBV show?
Lymphocytosis
125
Apart from a blood film, what other diagnostic tests could you do for EBV?
Viral PCR | Monospot (Heterophile antibodies produced by immune cells when exposed to EBV)
126
Name 4 cancers associated with EBV
Burkitts Lymphoma Hodgekin's Lymphoma B Cell Lymphoma Gastric Cancer
127
How do immunocompetent people infected with CMV (HHV5) present?
Often asymptomatic May present as hepatitis May present like Infectious Mononucleosis
128
How would immunocompromised people present with CMV?
Pneumonia - Fever, SOB
129
Who is at risk of congenital CMV?
When mothers do not have pre-existing immunity
130
How would congenital CMV present?
May appear healthy in utero Sensorineural hearing loss Mental Retardation Cerebral Palsy
131
What situation puts patients at risk of CMV?
Organ Transplant (can even occur if patient is seropositive due to different strains)
132
Only immunodeficient and congenital patients are treated for CMV, what are they treated with?
Ganciclovir
133
How can CMV be prevented in transplantation?
both seronegative - leukodepleted blood and products | recipient serongeative - prophylaxis with Ganciclovir
134
What are the symptoms of Neisseria Gonorrhoea infections in men and women respectively?
Men - Urethral discharge/Dysuria | Women - Discharge/Dysuria/Lower abdo pain/Altered menstrual bleeding
135
How would you investigate suspected Gonorrhoea?
NAAT on first catch urine (men) or endocervical swab (women)
136
How would you manage Gonorrhoea pharmacologically?
500mg Ceftriaxone IM | 1g Azithromycin PO
137
Give two complications of Gonorrhoea each for men and women
Men - Prostatitis, Epididymitis | Women - Salpingitis, Ectopic Pregnancy
138
How would Chlamydia present in a woman?
Dysparenuria Dysuria Post Coital Bleeding Increased Discharge
139
What is an atypical presentation of Chlamydia?
Reiter's Syndrome (Urethritis, Arthritis, Conjunctivitis)
140
How is Chlamydia managed pharmacologically?
100mg Doxycycline BD for one week
141
Name four ways Syphilis can be transmitted
Sexual contact with infectious lesions Vertical transmission in utero Blood transfusions Break in skin
142
How does primary syphilis present?
Develops at site of infection less than 3 months after Progresses from macule - papule - chancre Enlarged regional lymph nodes
143
What is a chancre?
Painless ulcer with central sloughing and rolled edges
144
How does secondary syphilis present?
Occurs roughly 6 weeks after primary infection Night time headaches Malaise Slight fever Polymorphic rash affecting palms, soles of feet and face
145
Name the three categories of tertiary syphilis
Neurological (may be asymptomatic or may have sensory ataxia, dementia etc) Cardiovascular (Aortitis) Gummata (Inflammatory nodules/plaques in any organ which may be locally destructive)
146
How can you investigate Syphilis?
Treponemal Enzyme Immunoassay for IgM (early) or IgG
147
How would you treat Primary, Secondary and early latent Syphilis?
Benzathine Penacillin 2.4 mega units IM
148
How would you treat late latent Syphilis?
Benzathine Penicillin weekly for 3 weeks
149
Name two complications of Syphilis or its treatment
Miscarriage/Stillbirth | Jarisch Herxheimer Reaction (to treatment, febrile, headache, myalgia, chills)
150
What strains of HPV cause genital warts?
HPV6 and HPV11
151
How might Genital Warts present?
Painless lesions that may cause itching/bleeding/dysparenuria
152
How would you educate a patient with Genital Warts?
The virus has a long latent period Recurrence of warts does not mean reinfection with virus/infidelity Condom use until lesions have resolved
153
How would you treat Genital Warts?
May choose no treatment, will regress spontaneously in 6m Non Keratinised - Podophyllotoxin cream Keratinised - Imiquimod Cream
154
What is Trichomonas Vaginalis
A protozoal infection spread almost exclusively by sexual intercourse
155
What is 'Strawberry Cervix'
Cervicitis caused by Trichomonas Vaginalis causing a strawberry appearance
156
How is Bacterial Vaginosis caused?
When Gardnerella Vaginalis outgrow the lactobacilli which normal inhabit the vagina, increasing the pH
157
Name 3 protective factors of Bacterial Vaginosis
COCP Condom Use Circumcised Partner
158
How is Bacterial Vaginosis managed?
Oral Metronidazole 400-500mg BD for 5-7 days
159
What is Schistosomiasis?
Fluke infection transmitted by contaminated water
160
How would acute Schistosomiasis present?
``` Swimmer's Rash Katayama Syndrome (Fever, Urticaria, Diarrhoea) ```
161
How would chronic Schistosomiasis present?
``` Intestinal Disease (pain,bloody stools) Urogenital Disease (Dysuria, CKD, Bladder Cancer) Lung Disease (Pulmonary Htn) ```
162
How is Schistosomiasis diagnosed?
Ova in urine/faeces Abdo Xray - Bladder Calcification USS - Hydronephrosis and thickened bladder wall
163
How is Schistosomiasis treated?
Praziquental | Steroids for Katayama Fever
164
Describe the pathophysiology of Tetanus
Caused by anaeobic Clostrodium Tetani spores in soil Enters small wounds and produces neurotoxin (Tetanospasmin) Neurotoxin disseminates via blood and lymphatics causing unopposed muscle contraction and spasm Incubation of 3d to 3w
165
How would generalised Tetanus present?
``` Prodrome (fever,malaise,headache) Trismus (lock jaw) Neck Stiffness Swallowing Difficulties Muscular Spasms ```
166
How is Tetanus managed?
In ITU IV Tetanus IG Metronidazole Benzodiazepines for spasms
167
Describe two screening methods for Latent TB
Mantoux | IGRA (Quantiferon or T Spot)
168
What do the results of the Mantoux test mean?
Negative: <6mm induration Positive: >6mm induration Strongly Positive: >15mm induration

Dan Medicine (10 decks)

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