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MRCP > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

Post-exposure prophylaxis for Hep C?

A

none

> do monthly PCR - if seroconversion then IFN +/- ribavarin

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2
Q

what test remains positive after treatment in syphilis?

A

TPHA - treponemal specific antibody tests

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3
Q

most common isolated organism following dog / animal bite?

A

Pasteurella multocida

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4
Q

mx of animal bite?

A

cleanse wound + Co-amoxiclav

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5
Q

most common causes of viral meningitis?

A

enteroviruses e.g. coxsackie B, echovirus

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6
Q

Ix of Aspergilloma?

A

CXR: rounded opacity, may seen Crescent sign

High titres Aspergillus precipitins

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7
Q

features of Leptospirosis?

A

early phase: fever, flu-like symptoms

  • subconjunctival suffusion (redness)/haemorrhage
  • bilateral calf myalgia

second immune phase may lead to more severe disease (Weil’s disease):

  • AKI (seen in 50%)
  • hepatitis: jaundice, hepatomegaly
  • aseptic meningitis
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8
Q

Ix of leptospirosis?

A

serology: antibodies to leptospirosis develop after ~7d,

PCR, culture (takes several weeks)

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9
Q

Mx of leptospirosis?

A

high dose benzylpenicillin or doxycycline

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10
Q

Features of Q fever?

A

fever, malaise, PUO.

  • transaminitis
  • atypical pneumonia
  • culture-negative endocarditis
  • exposure to farm animals
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11
Q

organism implicated in Q fever?

A

coxiella burnetii, a rickettsia

  • source; typically an abattoir, cattle/sheep, infected dust
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12
Q

mx of Q fever?

A

doxycycline

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13
Q

IV dexamethasone should be given to reduce the risk of neurological sequelae, but BNF advise to withhold if:

A

septic shock, meningococcal septicaemia, immunocompromised, meningitis following surgery

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14
Q

Mx of meningitis if patient has immediate hypersensitivity reaction to penicillin or to cephalosporins?

A

chloramphenicol

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15
Q

1st line mx of gonorrhoea?

A

Single dose IM ceftriaxone 1g

  • if ceftriaxone refused: oral cefixime 400mg + oral azithromycin 2g single doses
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16
Q

Key features of disseminated gonococcal infection?

A

tenosynovitis, migratory polyarthritis, dermatitis

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17
Q

Features include diarrhoea, abdominal pain, papulovesicular lesions where the skin has been penetrated by infective larvae e.g. soles of feet and buttocks,

larva currens: pruritic, linear, urticarial rash, if the larvae migrate to the lungs a pneumonitis similar to Loeffler’s syndrome may be triggered

A

Strongyloides stercoralis

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18
Q

Mx of strongyloides stercoralis?

A

Ivermectin (1st line) and -bendazoles (2nd line- albendazole)

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19
Q

perianal itching, particularly at night; girls may have vulval symptoms

A

entorebius vermicularis (pinworm)

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20
Q

diagnosis of enterobius vermicularis (pinworm) infection?

A

apply stick plastic tape to perianal area and send to lab for microscopy to see eggs

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21
Q

mx of enterobius vermicularis (pinworm)?

A

-bendazoles

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22
Q

Larvae penetrate skin of feet; gastrointestinal infection → anaemia
Thin-shelled ova

A

Ancylostoma duodenale, necator americanus (hookworms)

Mx: -bendazoles

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23
Q

Transmission by deer fly and mango fly

Causes red itchy swellings below the skin called ‘Calabar swellings’, may be observed when crossing conjunctivae

A

Loa Loa

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24
Q

Mx of Loa Loa infection?

A

diethylcarbamazine

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25
Q

Typically develops after eating raw pork

Features include fever, periorbital oedema and myositis (larvae encyst in muscle)

A

trichinella spiralis

mx: -bendazoles

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26
Q

Causes ‘river blindness’. Spread by female blackflies

Features include blindness, hyperpigmented skin and possible allergic reaction to microfilaria

A

Onchocerca volvulus

mx: ivermectin

rIVERblindness = IVERmectin

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27
Q

Transmission by female mosquito

Causes blockage of lymphatics → elephantiasis

A

Wucheria Bancrofti

  • mx: diethylcarbamazine
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28
Q

Mx of wucheria Bancrofti?

A

diethylcarbamazine

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29
Q

Eggs are visible in faeces

May cause intestinal obstruction and occasional migrate to lung (Loffler’s syndrome)

A

ascaris lumbricoides (giant roundworm)

mx: -bendazoles

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30
Q

Transmission through ingestion of eggs in dog faeces. Definite host is dog, which ingests hydatid cysts from sheep, who act as an intermediate host. Often seen in farmers.

Features include liver cysts and anaphylaxis if cyst ruptures (e.g. during surgical removal)

A

Echinococcus granulosus (tapeworm)

mx: -bendazoles

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31
Q

Often transmitted after eating undercooked pork. Causes cysticercosis and neurocysticercosis, mass lesions in the brain ‘swiss cheese appearance’

A

Taenia solum (tapeworm)

mx: -bendazoles

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32
Q

mx of tapeworms?

A

-bendazoles

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33
Q

Hosted by snails, which release cercariae that penetrate skin.
Causes ‘swimmer’s itch’ - frequency, haematuria. Risk factor for squamous cell bladder cancer

A

Schistosoma haematobium

mx: praziquantel

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34
Q

mx of schistosomiasis?

A

praziquantel

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35
Q

features of strongyloidiasis?

A
  • GI symptoms: bloating, discomfort, diarrhoea, larvae passed in stool
  • larva currens: urticarial band that typically starts in the peri-anal area. (rash rapidly migrates) -> this is the larvae in the skin
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36
Q

Features of toxoplasmosis?

A
  • accounts for 50% of cerebral lesions in patients with HIV
  • constitutional symptoms, headache, confusion, drowsiness
  • CT: usually single/ multiple ring enhancing lesion +/- mass effect
  • in immunocompetent patients: symptomatic, or presents similar to infectious mono (Fever, LNpathy, malaise)
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37
Q

Mx of toxoplasmosis?

A

sulfadiazine and pyrimethamine

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38
Q

Features of primary CNS lymphoma?

A
  • 30% of cerebral lesions in HIV
  • assoc w EBV
  • CT; single/ multiple homogenous enhancing lesions
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39
Q

tx of Primary CNS lymphoma?

A

steroids (may significantly reduce tumour size), chemotherapy (e.g. methotrexate) +/- whole brain irradiation. surgery may be considered

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40
Q

Ix to differentiate between toxoplasmosis and Primary CNS lymphoma?

A

Thallium SPECT

Toxoplasmosis: Thallium spect NEGATIVE
Lymphoma; thallium SPECT POSITIVE

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41
Q

Features of cryptococcal CNS infection in HIV?

A

meningitis, headache, fever, malaise, N+v, seizures, focal neurological deficit

  • CSF: high opening pressure, India ink test positive
  • CT: meningeal enhancement, cerebral oedema
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42
Q

Features of botulism

A 
patient usually fully conscious with no sensory disturbance
flaccid paralysis
diplopia
ataxia
bulbar palsy
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43
Q

Mx of botulism?

A

botulism antitoxin and supportive care

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44
Q

mx of giardiasis?

A

metronidazole

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45
Q

Ix of suspected meningococcal septicaemia?

A

blood cultures - might be negative if taken after abx
blood PCR- sensitivity of over 90%
lumbar puncture is usually contraindicated
full blood count and clotting to assess for disseminated intravascular coagulation

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46
Q

pathophysiology of tetanus?

A
  • clostridium tetani releases tetanospasmin exotoxin

- tetanospasmin prevents release of GABA

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47
Q

features of tetanus?

A

prodrome fever, lethargy, headache
trismus (lockjaw)
risus sardonicus (spasm of facial muscle - appears to be grinning)
opisthotonus (arched back, hyperextended neck)
spasms (e.g. dysphagia)

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48
Q

Mx of tetanus?

A

supportive: ventilatory support, muscle relaxants e.g. diazepam
IM human tetanus Ig for high risk wounds
metronidazole as antibiotic of choice

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49
Q

features of Cat scratch disease?

A

fever, history of a cat scratch, regional lymphadenopathy
headache, malaise
- Bartonella henselae (gram -ve rod)

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50
Q

1st line ix for suspected ascending cholangitis?

A

USS abdomen

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51
Q

most common organisms in ascending cholangitis?

A
  • E coli most common

followed by klebsiella, enterococcus, streptococcus

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52
Q

Reynolds pentad of ascending cholangitis?

A

Charcot’s triad: fever, RUQ pain, jaundice

+ confusion and hypotension

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53
Q

Tx of ascending cholangitis?

A

ERCP- usually after 72h of abx

Percutaneous transhepatic cholangiogram and biliary drain

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54
Q

features of congenital toxoplasmosis?

A
  • neurological damage to unborn child: cerebral calcification, hydrocephalus, chorioretinitis
  • ophthalmic damage: retinopathy, cataracts.
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55
Q

mx of toxoplasmosis in immunocompetent patients?

A

no treatment required unless patient has a severe infection or is immunosuppressed

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56
Q

Ix of choice to diagnose acute Hep C infection?

A

HCV RNA

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57
Q

`complications of chronic hep c?

A
  • rheumatological problems: arthralgia, arthritis
  • eye problems: Sjogren’s syndrome
  • cirrhosis (5-20% of those with chronic disease)
  • hepatocellular cancer
  • cryoglobulinaemia: typically type II (mixed monoclonal and polyclonal)
  • porphyria cutanea tarda (PCT)
  • membranoproliferative glomerulonephritis
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58
Q

Mx of chronic HCV infection?

A

treatment depends on viral genotype- this should be tested prior to treatment
- combination of protease inhibitors (e.g. daclatasvir + sofosbuvir or sofosbuvir + simeprevir) +/- ribavarin

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59
Q

mx of listeria meningitis?

A

IV amoxicillin + gentamicin

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60
Q

Mx of listeriosis in pregnancy?

A

amoxicillin

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61
Q

complications of malaria?

A

cerebral malaria: seizures, coma

  • acute renal failure: secondary to intravascular haemolysis
  • ARDS
  • hypoglycaemia
  • DIC
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62
Q

Mx of severe falciparum malaria?

A
  • if parasite count >2%, IV artesunate

- if Parasite count >10%, + exchange transfusion

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63
Q

Most common organism found in central line infections

A

Staphylococcus epidermidis

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64
Q

vaccines which should not be given to immunocompromised?

A

live attenuated

  • BCG
  • Yellow fever
  • Oral polio
  • Intranasal influenza
  • Varicella
  • Measles, mumps and rubella (MMR)
  • oral rotavirus/ typhoid
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65
Q

1st line mx of UTI in pregnant woman in first trimester?

A

nitrofurantoin

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66
Q

mx of acute pyelonephritis?

A

broad spec cephalosporin or quinolone for 10-14 days

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67
Q

Viral meningitis: but LP shows particularly low glucose?

A
  • normally CSF glucose in viral meningitis should be 60-80% plasma glucose
  • mumps assoc low glucose
  • also herpes encephalitis
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68
Q

Features of leprosy?

A
  • patches of hypopigmented skin typically affecting the buttocks, face, and extensor surfaces of limbs
  • sensory loss
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69
Q

Mx of multibacillary (>6 lesions) leprosy?

A

triple therapy: rifampicin, dapsone, clofazimine

- for 12 months

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70
Q

mx of shigella diarrhoea?

A

usually self limiting and does not require antibiotic treatment

  • safety net - if severe disease, immunocompromised, bloody diarrhoea -> give ciprofloxacin
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71
Q

Ix of Lyme disease?

A
  • clinical diagnosis if erythema migrans present -> indication to start abx
  • ELISA antibodies to Borrelia burgdoferi is 1st line
  • if negative but high suspicion, repeat ELISA 4-6 wks after first
  • if equivocal: immunoblot test for Lyme disease
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72
Q

Mx of disseminated Lyme disease?

A

Ceftriaxone

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73
Q

Mx of Lyme disease?

A

doxycycline

amoxicillin in pregnancy

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74
Q

most common cause of non-falciparum malaria

A

Plasmodium vivax

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75
Q

1st line mx for Plasmodium vivax and Plasmodium ovale?

A

Chloroquine or Artemisin-based combination therapy (e.g. Artemether-lumefantrine)

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76
Q

What should be given to patients with ovale or vivax malaria following acute treatment to prevent relapse?

A

primaquine

- to destroy liver hypnozoites and prevent relapse

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77
Q

Features of yellow fever?

A

sudden onset high fever, rigors, N+V, bradycardia. Jaundice, haematemesis, oliguria.
- councilman bodies (inclusion bodies) may be seen in the hepatocytes

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78
Q

Pathophysiology of Dengue fever?

A
  • can progress to viral haemorrhagic fever
  • transmitted by Aedes mosquito
  • form of DIC can develop
  • low Platelets, raised transaminase levels
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79
Q

mx of dengue fever?

A

entirely symptomatic

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80
Q

Ix of legionella pneumonia?

A

Urinary antigen

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81
Q

causative agent of hairy leukoplakia?

A

EBV

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82
Q

Causative agent of primary CNS lymphoma?

A

EBV

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83
Q

Diagnosis of Infectious mononucleosis?

A

Monospot test (heterophil antibody test) in 2nd week of illness + FBC

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84
Q

Mx of infectious mono?

A

Supportive

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85
Q

post-exposure prophylaxis for Hep B?

A
  • known responder to vaccine: booster dose

- non responder/ in the process of vaccination: Hep B IG + vaccine

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86
Q

features of Chancroid?

A
  • haemophilus ducreyi
  • PAINFUL genital ulcers
  • unilateral, painful inguinal LN enlargement
  • ulcers typically have a sharply defined, ragged, undermined border
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87
Q

Features of Lymphogranuloma venereum?

A
  • chlamydia trachomatis
  • stage 1: small painless pustule -> ulcer
  • stage 2: painful inguinal Lymphadenopathy
  • stage 3: proctocolitis
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88
Q

treatment of lymphogranuloma venereum?

A

doxycycline

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89
Q

Secondary features of Syphilis?

- occurs 6-10 weeks after primary infection

A

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

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90
Q

Tertiary features of Syphilis?

A
  • 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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91
Q

features of congenital syphilis?

A
  • blunted upper incisor teeth (Hutchinson’s teeth), “mulberry” molars
  • rhagades (linear scars at the angle of the mouth),
  • keratitis
  • saber shins
  • saddle nose
  • deafness
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92
Q

Mx of HSV gingovostomatitis?

A

oral acyclovir, chlorhedixine mouthwash

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93
Q

Mx of HSV cold sores?

A

topical acyclovir

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94
Q

Mx of genital herpes?

A

oral aciclovir

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95
Q

rash, headache + single/ multiple eschars + history of recent foreign travel?

A

rickettsial infections

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96
Q

Features of listeria monocytogenes infection?

A

diarrhoea, flu-like illness
pneumonia , meningoencephalitis
ataxia and seizures

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97
Q

Ix of suspected listeria infection?

A

blood cultures

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98
Q

Complications of listeria infection in pregnancy?

A

miscarriage, premature labour, stillbirth and chorioamnionitis

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99
Q

Mx of preventing tetanus if vaccination hx incomplete or unknown? OR full course of tetanus vaccines, with last dose >10 years ago

A

reinforcing dose of vaccine, regardless of wound severity

- high risk wounds: + Tetanus Ig

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100
Q

Mx of preventing tetanus if full course of tetanus vaccines, with last dose <10 yr ago?

A

Nothing regardless of wound severity

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101
Q

most commonly affected site of necrotising fasciitis?

A

perineum (Fournier’s gangrene)

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102
Q

Management of necrotising fasciitis?

A

urgent surgical debridement + IV abx

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103
Q

Classification of necrotising fasciitis?

A

type 1: most common. mixed anaerobes and aerobes. often post surgery in diabetics
type 2: streptococcus pyogenes

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104
Q

which type of malaria is associated with nephrotic syndrome?

A

plasmodium malariae

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105
Q

Most frequent and severe manifestation of Chagas disease?

A

cardiomyopathy

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106
Q

Features of Sleeping sickness aka African trypanosomiasis?

A
  • trypanosome chancre- painless subcut nodule at site of infection
  • intermittent fever
  • enlargement of posterior cervical LNs
  • later: CNS involvement e.g. somnolence, headaches, mood changes, meningoencephalitis
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107
Q

Types of African trypanosomiasis/ Sleeping Sickness?

A

Trypanosoma rhodisiense: East Africa, acute course (Rapid)

Trypanosoma gambiense: West Africa, gradual course

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108
Q

Mx of African trypanosomiasis/ Sleeping Sickness?

A

early disease: IV pentamidine/ Suramin

later disease/ CNS involvement: IV melarsoprol

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109
Q

Features of Chagas disease (aka American trypanosomiasis)?

A

95% are asymptomatic in the acute phase, sometimes will see a chagoma (erythematous nodule at site of infection) and periorbital oedema.

  • parasites in HEART: myocarditis, dilated cardiomyopathy (w apical atrophy) and arrhythmias
  • and GI TRACT: megaoesophagus and megacolon -> dysphagia/ constipation
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110
Q

Mx of Chagas disease?

A

acute: benznidazole/ nifurtimox
chronic: treat the complications e.g. heart failure

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111
Q

Features of Rabies

A

prodrome: headache, fever, agitation
hydrophobia: water-provoking muscle spasms
hypersalivation
Negri bodies: cytoplasmic inclusion bodies found in infected neurons

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112
Q

Mx of preventing rabies Following an animal bite in at-risk countries?

A
  • wash wound
  • if already immunised: 2 further doses of vaccine
  • not immunised: Full course vaccination + Human Rabies IG
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113
Q

Most common opportunistic infection in AIDS?

A

pneumocystis carinii pneumonia

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114
Q

Complications of pneumocystis carinii pneumonia?

A 
common: pneumothorax
Rare:
- hepatosplenomegaly
- lymphadenopathy
- choroid lesions
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115
Q

Mx of pneumocystis carinii pneumonia?

A
  • Co-trimoxazole
  • Severe: IV pentamidine
  • aerosolised pentamidine is an alternative, but less effective
  • Steroids if hypoxic!!
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116
Q

Ix of chronic Hepatitis C?

A

anti-HCV antibody test

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117
Q

Management of Cysticercosis (type of tape worm)?

A

Niclosamide

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118
Q

Mx of Hydatid disease?

A

albendazole

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119
Q

Features of Hydatid disease?

A
  • caused by dog tapeworm Echinococcus granulosus
  • Dogs ingesting hydatid cysts from sheep liver
  • often seen in farmers
  • can cause liver cysts
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120
Q

Mx of meningeal tuberculosis?

A

RIPE + steroids for 12 months

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121
Q

Side effects of ethambutol?

A

optic neuritis: check visual acuity before and during treatment

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122
Q

Side effects of pyrazinamide?

A

hyperuricaemia causing gout
arthralgia, myalgia
hepatitis

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123
Q

Side effects of isoniazid?

A

peripheral neuropathy: prevent with pyridoxine (Vitamin B6)
hepatitis, agranulocytosis
liver enzyme inhibitor

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124
Q

Side effects of rifampicin?

A

potent liver enzyme inducer
hepatitis, orange secretions
flu-like symptoms

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125
Q

MOA of Aciclovir/ Ganciclovir?

A

DNA polymerase inhibitor

- Guanosine analogue, phosphorylated by thymidine kinase, which in turn inhibits the viral DNA polymerase

126
Q

MOA of Ribavarin (used in Chronic hep C, RSV)?

A
  • Inhibits IMP (inosine monophosphate) dehydrogenase, interferes with the capping of viral mRNA
  • guanosine analogue
127
Q

MOA of Amantadine (e.g. influenza/ parkinsons disease)?

A 
inhibits uncoating (M2 protein) of virus in cell
- also releases dopamine from nerve endings
128
Q

MOA of Oseltamivir (used in influenza)?

A

Inhibits neuraminidase

129
Q

MOA of Foscarnet (used in CMV/ HSV if not responding to aciclovir)?

A

Pyrophosphate analogue which inhibits viral DNA polymerase

130
Q

MOA of IFN-alpha (used in Hep B/C, hairy cell leukaemia)?

A

human glycoproteins which inhibit synthesis of mRNA

131
Q

Class of medications:

Zidovudine, Didanosine, lamivudine, stavudine, zalcitabine

A

NRTI

- nucleoside analogue reverse transcriptase inhibitors

132
Q

Class of medications:

Indinavir, nelfinavir, ritonavir, saquinavir?

A

Protease inhibitors

133
Q

Class of medications:

e.g. nevirapine, efavirenz?

A

NNRTI

- non-nucleoside analogue reverse transcriptase inhibitors

134
Q

Ix of choice for diagnosing chlamydia?

A

NAATs

  • nucleic acid amplification tests
  • urine (1st line for men), vulvovaginal (1st line for women)/ cervical swab
135
Q

1st line Management of chlamydia?

A

7 day course of Doxycycline

  • doxycycline CI: azithromycin
136
Q

Mx of chlamydia in pregnancy?

A

azithromycin, erythromycin or amoxicillin

137
Q

what does strep pyogenes (Group A beta haemolytic streptococcus) cause

A

Erysipelas, impetigo, cellulitis, type 2 Nec fasc, pharyngitis/tonsillitis, rheumatic fever, post strep glomerulonephritis, scarlet fever

138
Q

`mx of cutaneous anthrax?

A

Ciprofloxacin

139
Q

Main organism in BV?

A

gardnerella vaginalis

- gram + coccobacilli

140
Q

Acute manifestation of Schistosomiasis?

A 
- swimmers' itch
acute schistosomiasis syndrome (Katayama fever):
-- fever
-- urticaria/angioedema
-- arthralgia/myalgia
-- cough
-- diarrhoea
-- eosinophilia
141
Q

Features of chronic Schistosoma haematobium infection?

A
  • egg clusters (pseudopapillomas) deposited in bladder, causing inflammation
  • Xray shows calcification of egg clusters
  • obstructive uropathy/ kidney damage
  • risk factor for squamous cell bladder ca
  • frequency, haematuria, bladder calcification
142
Q

Bladder calcification on X-ray?

A

Schistosoma haematobium

143
Q

Mx of schistosome haematobium?

A

single oral dose of praziquantel

144
Q

Features of schistosome mansoni/ japonicum infection?

A
  • > chronic GI symptoms: intermittent, bloody diarrhoea
  • > progressive hepatomegaly and splenomegaly due to portal vein congestion
  • > liver cirrhosis, variceal disease, cor pulmonate
145
Q

most common cause of infective diarrhoea in HIV patients?

A

cryptosporidium

146
Q

Ix of Cryptosporidium diarrhoea?

A

Modified Ziehl-Neelsen stain of stool: characteristic red cysts of Cryptosporidium

147
Q

Mx of Cryptosporidium diarrhoea in HIV?

A

supportive

148
Q

Mx of mycobacterium avian intracellulare diarrhoea in HIV?

A

Rifampicin, ethambutol and clarithromycin

149
Q

Mx of Staphylococcal toxic shock syndrome

A

removal of infection focus (e.g. retained tampon)
IV fluids
IV antibiotics

150
Q

Pneumonia related to cold sores?

A

strep pneumoniae

151
Q

Organism implicated in Rocky Mountain spotted fever?

A

Rickettsia ricketsii

152
Q

Features of Rocky Mountain spotted fever?

A

headache, fever, rash - initially maculopapular before becoming vasculitic
- tick-borne

153
Q

Features of Brucellosis

A
  • exposure to unpasteurised cheese
  • hyperhidrosis with “wet hay” smell
  • fluctuating temperatures
  • transient arthralgia/ myalgia
  • hepatosplenomegaly
  • sacroiliitis: spinal tenderness may be seen
  • complications: osteomyelitis, infective endocarditis, meningoencephalitis, orchitis
  • leukopenia often seen
154
Q

Best test for diagnosis of Brucellosis?

A

Brucella serology

155
Q

Mx of Brucellosis?

A

doxycycline and streptomycin

156
Q

Prophylaxis of Mycobacterium avium intracellulare in HIV patients with CD4<100 cells/mm3

A

clarithromycin/ azithromycin

157
Q

MOA of Macrolides e.g. clarithromycin/ erythromycin and Clindamycin and Chloramphenicol?

A

Binds to 50S subunit, inhibiting translocation of tRNA

exception: Chloramphenicol - binds to 50S subunit, inhibits peptide transferase

158
Q

MOA of aminoglycosides e.g. gentamicin and tetracyclines e.g. doxycycline?

A

Binds to 30S subunit

159
Q

What are some gram negative cocci?

A

Neisseria meningitidis + Neisseria gonorrhoea, Moraxella catarrhalis

160
Q

What are some Gram positive rods?

A 
ABCD L
A. - Actinomyces
B - Bacillus anthracis (anthrax)
C- Clostridium
D- Diphtheria: Corynebacterium diphtheriae
L- Listeria monocytogenes
161
Q

For a patient undergoing an elective splenectomy, when to give the pneumococcal vaccine?

A

2 week before surgery

162
Q

features of measles?

A

prodrome: irritable, conjunctivitis, fever
Koplik spots (before rash): white spots (‘grain of salt’) on buccal mucosa
rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent
diarrhoea occurs in around 10% of patients

163
Q

Ix of measles?

A

IgM antibodies to measles

164
Q

Most common complication of measles?

A

otitis media

165
Q

most common cause of death from measles?

A

pneumonia

166
Q

Mx of Lassa fever?

A

ribavarin

167
Q

How is Lassa fever transmitted?

A

contact with rat faeces

168
Q

characteristic CT findings of numerous small focal calcification throughout both hemispheres, with no enhancement

A

Neurocysticercosis

169
Q

Most common cause of cutaneous larva migrans?

A

Ancylostoma braziliense

170
Q

Most common cause of visceral larva migrans?

A

Toxocara canis

  • Eye granulomas, liver/ lung involvement
171
Q

Features of Orf?

A
  • sheep/ goat farmers
  • hands and arms: initially small raised, red-blue papules
  • later may increase in size to 2-3cm -> flat topped and haemorrhagic
172
Q

Features of Lyme disease?

A

Early:

  • erythema migrans
  • systemic symptoms: malaise, fever, arthralgia

Later features:

  • CVS: heart block, myocarditis
  • neurological: cranial nerve palsies, meningitis
  • polyarthritis
173
Q

Raltegravir, elvitegravir, dolutegravir

- MOA?

A
  • gravir

- INTEGRASE inhibitors

174
Q

indinavir, nelfinavir, ritonavir, saquinavir

- MOA?

A

-navir

PROTEASE inhibitors

175
Q

Which protease inhibitor is a potent inhibitor of the p450 system?

A

ritonavir

176
Q

Maraviroc, enfuvirtide?

MOA

A

Entry inhibitors

  • maraviroc (binds to CCR5, preventing an interaction with gp41),
  • enfuvirtide (binds to gp41, also known as a ‘fusion inhibitor’)
177
Q

Screening for latent TB?

A

Mantoux test

178
Q

Features of Chikungunya?

A
  • abrupt onset high fever
  • severe joint pain +/- joint swelling
  • myalgia, headache, fever

Mx: symptomatic

179
Q

Mx of paucibacillary leprosy (5 or less lesions)?

A

rifampicin and dapsone for 6 months

180
Q

Features of Diphtheria?

A
  • recent visitors to Eastern Europe/Russia/Asia
  • sore throat with a ‘diphtheric membrane’ - grey, pseudomembrane on the posterior pharyngeal wall
  • bulky cervical lymphadenopathy -> ‘bull neck’ appearance
  • neuritis e.g. cranial nerves
  • heart block
181
Q

Ix of Diphtheria?

A

culture of throat swab: use tellurite agar or Loeffler’s media

182
Q

Mx of Diphtheria?

A

IM penicillin, diphtheria antitoxin

183
Q

C botulinum vs C tetani

A

C botulinum:
- prevents ACh release -> flaccid paralysis

C tetani:
- prevents release of glycine from Renshaw cells in the spinal cord -> spastic paralysis

184
Q

Features of visceral leishmaniasis (kala-azar)?

A
  • fever, sweats, rigors
  • massive splenomegaly. hepatomegaly
  • poor appetite*, weight loss
  • grey skin - ‘kala-azar’ means black sickness
  • pancytopaenia secondary to hypersplenism
185
Q

Gold standard for diagnosis of visceral leishmaniasis?

A

bone marrow/ splenic aspirate

186
Q

Features of Staphylococcal toxic shock syndrome?

A
  • fever: temperature > 38.9ºC
  • hypotension: systolic blood pressure < 90 mmHg
  • diffuse erythematous rash
  • desquamation of rash, especially of the palms and soles
  • involvement of three or more organ systems: e.g. gastrointestinal (diarrhoea and vomiting), mucous membrane erythema, renal failure, hepatitis, thrombocytopenia, CNS involvement (e.g. confusion)
187
Q

organism implicated in granuloma inguinale?

A

Klebsiella granulomatis

188
Q

Painful vs painless genital ulcers

A

Painful:

  • Chancroid
  • HSV

Painless:

  • Syphilis
  • Lymphogranuloma venereum (Chlamydia trachomatis)
  • Donovanosis: klebsiella granulomatis
189
Q

Should live vaccines be given together?

A

can be given concomitantly on same day.

If not, should be given >/=4 wks apart.

190
Q

Which vaccines are conjugate vaccines?

- linked to proteins to make them more immunogenic

A
  • pneumococcus
  • haemophilus
  • meningococcus
191
Q

gram positive, catalase and coagulase positive cocci

A

Staph aureus

192
Q

gram positive, catalase +ve, coagulase NEG cocci?

A

Staph epidermidis, Staph saprophyticus

193
Q

Gram positive, catalase NEG, non haemolytic cocci?

A

Enterococcus

194
Q

Gram positive, catalase NEG, ALPHA haemolytic cocci?

A

Strep pneumoniae, Strep viridian’s

195
Q

Gram positive, catalase neg, beta haemolytic cocci?

A

e.g. Strep pyogenes, Strep agalactiae

196
Q

Mx of pelvic inflammatory disease?

A

oral ofloxacin + oral metronidazole
OR

IM ceftriaxone + oral doxycycline + oral metronidazole

197
Q

Rabbit/ beaver bite. erythematous papulo-ulcerative lesion at the site of the bite with reactive and ulcerating regional lymphadenopathy

A

Tularaemia

  • F. tularensis
  • tx: doxycycline
198
Q

Common organisms in human bite?

A 
Streptococci spp.
Staphylococcus aureus
Eikenella
Fusobacterium
Prevotella
199
Q

What parasitaemia count suggests a severe infection in Plasmodium knowlesi?

A

> 1%

  • due to fastest erythrocytic cycle -> capable of producing very high parasite counts in a short space of time.
200
Q

Causes of false positive VDRL/RPR anti-cardiolipin test?

A 
pregnancy
SLE, anti-phospholipid syndrome
TB
leprosy
malaria
HIV
201
Q

what vaccines are CI in HIV patients regardless of CD4 count?

A

Cholera CVD103-HgR
Intranasal Influenza
BCG
Oral polio

202
Q

Vaccinations one should get post splenectomy?

A

Haemophilus influenza (Hib) Meningitis A + C

  • annual influenza
  • pneumococcal vaccine every 5 years
  • Pen V prophylaxis
203
Q

Mx of Shigella?

A

if severe/ immunocompromised/ bloody diarrhoea: Ciprofloxacin

204
Q

Mx of cellulitis in pregnancy?

A

clarithromycin/ erythromycin

205
Q

Mx of cellulitis if allergic to penicillin?

A

clarithromycin/ doxycycline

206
Q

Mx of severe cellulitis?

A

co-amoxiclav, cefuroxime, clindamycin, ceftriaxone

207
Q

Diagnosis of mycoplasma pneumoniae?

A

Mycoplasma serology

208
Q

Features of japanese encephalitis?

A

headache, fever, seizures, confusion.

  • Parkinsonism features indicate basal ganglia involvement
  • may have flaccid paralysis

mx: supportive

209
Q

Diagnosis of Japanese encephalitis?

A

serology/ PCR

- flavivirus transmitted by culex mosquitoes

210
Q

Mx of non-gonococcal urethritis?

A

Oral azithromycin/ doxycycline

211
Q

Features of Zika virus?

A 
fever, rash
arthralgia/arthritis
conjunctivitis
myalgia
headache
retro-orbital pain
pruritus
212
Q

Strongest risk factor for melioidosis/ whitmore’s disease?

A

Diabetes mellitus

  • other RF: agriculture work, immunocompromised, chronic liver/renal/ lung disease
213
Q

Mx of Melioidosis/ Whitmore’s disease?

A

IV ceftazidime, imipenem/ meropenem for 10-14 days

followed by eradication therapy: oral TMP/SMX (+ doxycycline) for 3-6mo

214
Q

Organism implicated in Melioidosis/ Whitmore’s disease?

A

Burkholderia pseudomallei

215
Q

mx of cholera?

A

oral rehydration therapy,

doxycycline/ ciprofloxacin

216
Q

Leishmania donovani

A

Visceral leishmaniasis

217
Q

Leishmania braziliensis

A

Mucocutaneous leishmaniasis

218
Q

Leishmania tropica or Leishmania mexicana

A

Cutaneous leishmaniasis

219
Q

complications of lemierre’s syndrome- infectious thrombophlebitis of the IJV?

A

septic pulmonary emboli

220
Q

mx of close contacts of pneumococcal meningitis?

A

no action needed

221
Q

features of mucocutaneous leishmaniasis?

A

ulceration of skin + mucosae of nose, pharynx

222
Q

IX of entamoeba histolytica/ amoebic colitis?

A

stool microscopy: trophozoites if examined within 15 min/ kept warm “hot stool”
- stool PCR: now gold standard, not as sensitive but does not need to be examined within 15 mins

223
Q

mx of entamoeba histolytic/ amoebic colitis?

A

metronidazole followed by luminal amoebicide (e.g. diloxanide furoate)

224
Q

severe hepatitis in pregnant woman?

A

hep E

- pregnant women are at particular risk from hep E

225
Q

Rifampicin MOA?

A

inhibits RNA synthesis

226
Q

Amphotericin B MOA?

A

Binds with ergosterol (component of fungal cell membranes), forming pores -> lysis of cell wall + subsequent fungal cell death

227
Q

Terbinafine MOA?

A

inhibits the fungal enzyme squalene epoxidase, causing cellular death

  • used to treat ringworm, pityriasis versicoloured, fungal nail infections
228
Q

SE of trimethoprim?

A

myelosuppression

- transient rise in Creatinine: as trimethoprim competitively inhibits the tubular secretion of creatinine

229
Q

Post-exposure prophylaxis of HIV?

A

Triple therapy: Tenofovir + emtricitabine + raltegravir,

continued for at least 28 days.

230
Q

features of cutaneous leishmaniasis?

A
  • presents with a nodule 1-2 months after infected sandfly bite, which gradually ulcerates, often w thick fibrous crust over the surface
231
Q

Most common side effect of ribavarin?

A

haemolytic anaemia

- also teratogenic, must prevent pregnancy

232
Q

Mx of visceral leishmaniasis?

A

sodium stibogluconate IV or pentamidine

233
Q

1-3 beta D glucan levels in PCP?

A

BDG is a polysaccharide in the walls of Pneumocystis jirovecii cysts
- will be elevated in PCP

234
Q

Malaria prophylaxis in patient with epilepsy? best option

A

Malarone (proguanil and atovaquone)

  • chloroquine resistance is present in some places + not recommended in seizures
  • mefloquine can cause seizures
235
Q

Which HIV medication might lead to renal stones?

A

indinavir

236
Q

Which HIV medication induces P450 system?

A

nevirapine

237
Q

Haemorrhagic fever with renal syndrome - endemic in Korea and other Asian countries?

A

Hantavirus

238
Q

Features of typhus?

A

fever, headache

  • black eschar at site of original inoculation
  • rash e.g. maculpapular or vasculitis
  • complications: deranged clotting, renal failure, DIC

mx: doxycycline

239
Q

Mx of typhus/ rickettsial diseases?

A

doxycycline

240
Q

ix of syphilitic ulcer?

A

swab ulcer and send for PCR

241
Q

Features of granuloma inguinale/ donovanosis?

A
  • klebsiella granulomatis
  • painless, spreading ulcer with friable edges
  • can become infected/ locally destructive
  • may lead to SCC
  • rarely heal without treatment
242
Q

1st line mx of epididymo-orchitis in >35?

A

ofloxacin

  • Gram negative enteric bacteria is most common
243
Q

empirical first line mx of osteomyelitis?

A

flucloxacillin

244
Q

Which human antigen is involved in the entry of Plasmodium vivax into the human red cell?

A

Duffy glycoprotein

- if not expressed, resistant to infection by Plasmodium vivax

245
Q

golden crusted lesions on face

A

impetigo

  • staph aureus
  • tx: topical fusidic acid
246
Q

Zanamivir in asthmatics?

A

may trigger bronchospasm

247
Q

What vaccines can’t be used in those with egg allergy?

A

yellow fever, live attenuated influenza

248
Q

best option for malaria prophylaxis in pregnancy?

A

mefloquine

249
Q
  • RF: tooth extractions, fractures of the jaw, periodontal abscesses
  • acute, usually odontogenic, abscess of floor of the mouth
  • can spread to involve head and neck
  • sulphur granules on microscopy
A

cervicofacial actinomycosis

tx: amoxicillin

250
Q

Hand foot mouth disease - organism?

A

coxsackie virus group A, type 16

251
Q

causes of tinea pedis/ athletes foot?

A

Trichophyton: multiple small microconidia
Microsporum: single microconidia/ multiseptate macroconidia
Epidermophyton: does not produce conidia

252
Q
  • soil/ thorn causing cut
  • begins as reddish/ non tender maculopapular lesion
  • over next few wks, similar nodules form along proximal lymphatic channels
  • break down to form a row of ulcers
A

Cutaneous sporotrichosis

  • caused by sporothrix schenckii
  • diagnosis through culture of biopsy samples on Sabouraud dextrose agar
  • Tx: itraconazole. if severe/ immunocompromised: IV amphotericin B
253
Q

Tx of Cutaneous sporotrichosis?

A

itraconazole.

if severe/ immunocompromised: IV amphotericin B

254
Q
  • South East asia (e.g. Thailand)
  • worker in a paddy field with regular contact with wet soil
  • fever, cough, pleuritic chest pain, bone pain, cellulitis
  • cutaneous abscesses
A

Melioidosis

  • Burkholderia pseudomallei
  • tx: IV Ceftazidime for at least 10 days
255
Q

What HIV medication may cause hypertriglyceridaemia?

A

protease inhibitors e.g. ritonavir, lopinavir

256
Q

Infectious mono severe tonsillar swelling -> possible respiratory obstruction … mx?

A

ENT rv + IV hydrocortisone

257
Q

What are the HACEK organisms of culture negative infective endocarditis?

A 
Haemophilus spp
Aggregatibacter spp
Cardiobacterium homonis
Eikenella corrodens
Kingella spp
258
Q

increasing PR interval in infective endocarditis?

A

suggests aortic root abscess

- need surgical referral

259
Q

Mx of chronic Hep C?

A

Daclatasvir (stops hep C viral replication) + sofosbuvir +/- ribavarin

260
Q

What type of bacteria is clostridium botulinum?

A

gram positive anaerobic bacillus

261
Q

Cryptosporidiosis in immunocompromised: management?

A

Rifaximin or nitazoxanide

262
Q

Options for antibiotic prophylaxis to prevent travellers’ diarrhoea? (In immunocompromised population)

A

ciprofloxacin, norfloxacin or rifaximin

263
Q

Hep B: management?

A

1st line: pegylated IFN alpha

2nd: tenofovir/ entecavir/ telbivudine

264
Q

Legionella pneumonia: management?

A

erythromycin/clarithromycin
OR
Levofloxacin if infection severe

265
Q

What viral haemorrhagic fever is associated with caves/ bats?

A

Marburg virus

266
Q

What is paragonimiasis?

A
  • common tropical infection (presents similarly to TB)
  • productive cough w brown / red sputum
  • constitutional symptoms
  • eosinophilia.
267
Q

Paragonimiasis: management?

A

praziquantel

268
Q

most common cause of epilepsy worldwide?

A

neurocysticercosis

269
Q

neurocysticercosis: treatment?

A

praziquantel / albendazole and prednisolone.

270
Q

neurocysticercosis: diagnosis?

A

Diagnosis is made with MRI or CT imaging.

Calcified cysts in skeletal muscle may be found incidentally on x-ray.

271
Q

HHV 5 = ?

A

CMV

272
Q

CMV infections in post transplant patient: management if there is ganciclovir resistance?

A

foscarnet or cidofovir

273
Q

spinal epidural abscess: most common causative organism?

A

staph aureus

274
Q

what organisms are group D Streptococci? (gram positive cocci)

A

Enterococcus

e.g. enterococcus faecalis (common gut commensal and cause of intra-abdominal infections

275
Q

Infuenza: 1st line management in severely immunocompromised individuals?

A

zanamivir

276
Q

necrotising fasciitis in chickenpox: most likely organism?

A

invasive group A streptococcus

277
Q

what is Yaws infection?

A
  • chronic infection that affects mainly skin, bone and cartilage
  • occurs mainly in low socio-economic communities in tropical areas of Africa, Asia and Latin America
  • caused by Treponema pertenue (a subspecies of Treponema pallidum)
  • yaws is a non-venereal infection
278
Q

primary yaws infection features?

A

a single skin lesion develops at the point of entry of the bacterium after 2-4 weeks. This nodule can break down into an exudative ulcer.

279
Q

secondary yaws infection features?

A

multiple lesions appear all over the body, more commonly over the face, trunk, genitalia and buttocks.

-> eventually widespread bone, joint and soft tissue destruction can occur.

280
Q

Management of brucellosis?

A

6 weeks of oral doxycycline with 3 weeks of either intramuscular streptomycin or intravenous gentamicin

Or

6 weeks of PO rifampicin and doxycycline

281
Q

antibiotic options for carbapenemase producing enterobacteriaceae (CPE)?

A

polymyxins e.g. colistin
tigecycline
fosfomycin
aminoglycosides e.g. gentamicin

282
Q

councilman bodies in hepatocytes?

A

Yellow fever

283
Q

TB: management in cases of confirmed isoniazid resistance?

A

rifampicin and ethambutol are continued for further 4 months after RIPE for 2 months

284
Q

difference in where to find the different sleeping sickness bugs?

A

Trypanosoma gambiense in West Africa e.g. Nigeria

and

Trypanosoma rhodesiense in East Africa

285
Q

Mx of tick borne encephalitis?

A

Supportive

286
Q

Diagnosis of tick borne encephalitis?

A

CSF/serum serology for TBE-specific antibody

287
Q

Mx of multi drug resistant TB?

A

18-24 months of at least 5 drugs

288
Q

Features of amoebic dysentery (entamoeba histolytica)?

A

profuse, bloody diarrhoea
- possible long incubation period

stool microscopy may show trophozoites if examined within 15 minutes or kept warm (‘hot stool’)

289
Q

Treatment of typhoid fever?

A

Cefotaxime/ ceftriaxone

Or ciprofloxacin

290
Q

What does Nocardia infection typically cause?

A
  • pneumonia in immunocompromised patients
  • may cause brain abscesses

Nocardia (gram positive rod)

291
Q

What does actinomycoses israelii infection normally cause?

A
  • chronic, progressive granulomatous disease
  • oral/facial abscesses with sulphur granules in sinus tracts
  • Possible abdominal mass (ie RIF)

> commensals become pathogenic when mucosal barrier breached.

292
Q

What does actinomycoses israelii infection normally cause?

A
  • chronic, progressive granulomatous disease
  • oral/facial abscesses with sulphur granules in sinus tracts
  • Possible abdominal mass (ie RIF)

> commensals become pathogenic when mucosal barrier breached.

293
Q

Risk factor for Abdominopelvic actinomycosis

A

Previous appendicitis

294
Q

Management of actinomycosis infection?

A
  • Long-term antibiotic therapy usually with penicillin
  • Surgical resection indicated for extensive necrotic tissue, non-healing sinus tracts, abscesses or where biopsy is needed to exclude malignancy.
295
Q

Who should get prophylaxis for close contacts of bacterial meningitis?

A

Close contacts for up to 7 days prior

296
Q

High loa loa microfilaraemia is associated with encephalopathy following treatment with which drugs?

A

Ivermectin or DEC

- CI if loa loa microfilaraemia exceeds 2500 mf/ml.

297
Q

most serious and frequent complications of Typhoid fever?

A

bowel perforation and haemorrhage

> caused by bacterial destruction of the Peyer’s patches in the small intestine and classically occurs late in the 2nd week of illness or early in the third week.

298
Q

What vaccinations can you not give AT ALL in HIV?

A
  • Cholera CVD103-HgR
  • Influenza-intranasal
  • Poliomyelitis-oral (OPV)
  • BCG
299
Q

What vaccinations can you give in HIV ONLY if CD4 count >200?

A

Measles, Mumps, Rubella (MMR)
Varicella
Yellow Fever

300
Q

What medication is unlikely to be effective in dual tropism HIV virus?

A

Maraviroc

  • blocks HIV binding to CCR5 receptor
  • not useful if the virus is ‘CXCR4 tropic’ or ‘dual tropic’
301
Q

What zoonotic vector transmits the Marburg virus (and causes a viral haemorrhagic fever)?

A

Bats and caves

302
Q

What anti HIV medication should be avoided if HLA B*5701 allele positive?

A

Abacavir

303
Q

most serious and frequent complications of Typhoid fever?

A

GI perforation and haemorrhage

  • caused by bacterial destruction of the Peyer’s patches in the small intestine and classically occurs late in the 2nd week of illness or early in the 3rd week
304
Q

tick borne malaria-like illness:

fevers, chills, riggers, haemolytic anaemia + haemoglobinuria

A

Babesiosis

  • intra-erythrocytic protozoan Babesia > destroy RBCs
  • frequent in endemic parts of USA e.g Long Island, New York, Nantucket, Massachusetts
  • if no spleen: infection will be more severe
305
Q

diagnosis of babesiosis?

A

often clinical

306
Q

management of immunocompetent individual with mild-mod babesia infection?

A

oral azithromycin + atovaquone

307
Q

management of severe babesia infection?

A

IV azithromycin + PO atovaquone (usually 7-10d)
or
IV clindamycin + oral quinine

if pt immunocompromised: may need up to 6/52 of tx

308
Q

management of severe babesia infection if high grade parasitaemia (>10%), severe haemolysis (Hb<10) or organ (liver, renal, lung) impairment?

A

exchange transfusion

309
Q

risk of transmission of hep c from mother to child?

A

6%

310
Q

are there any methods recommended to reduce risk of vertical transmission of hep c from mother > child?

A

no evidence based advice

311
Q

best method of confirming Strongyloides stercoralis eradication following treatment

A

Repeat serological testing

- post-treatment to pre-treatment titre ratio of < 0.6 = good indicator of treatment success.

312
Q

mx of CNS cryptococcal infection?

A

IV amphotericin B + flucytosine

MRCP (21 decks)

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