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AKT > Infectious diseases > Flashcards

Infectious diseases Flashcards

1
Q

Which pneumonia is associated with erythema multiforme?

A

Mycoplasma pneumoniae

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2
Q

Treatment for invasive diarrhoea

A

Ciprofloxacin

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3
Q

First line treatment for UTI in pregnant women

A

Nitrofurantoin (avoid if near term)

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4
Q

Second line treatment for UTI in pregnant women

A

Amoxicillin or cefalexin

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5
Q

Treatment of UTI in men

A

7 days trimethoprim or nitrofurantoin

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6
Q

Management of cellulitis

A

Flucloxacillin

If pen allergic: clarithromycin, erythromycin or doxycycline

Pen allergic + pregnant: erythromycin

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7
Q

Causes of genital warts

A

HPV 6 and 11

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8
Q

Causes of cervical cancer

A

HPV 16, 18 and 33

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9
Q

Treatment of genital warts

A

Topical podophyllum

Cryotherapy

Imiquimod 2nd line

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10
Q

What causes a chancroid?

A

Haemophilus ducreyi

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11
Q

What does haemophilius ducreyi cause?

A

Chancroid

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12
Q

Chancroid features

A

Painful genital ulcers with unilateral, painful inguinal lymph node enlargement

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13
Q

First line antibiotic for uncomplicated pneumonia

First line if pen allergic

A

amoxicillin

Pen allergic: doxycycline, clarithromycin

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14
Q

What should you add if you suspect pneumonia is secondary to influenza?

A

Flucloxacillin

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15
Q

First line antibiotic for atypical pneumonia

A

Clarithromycin

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16
Q

First line antibiotic for hospital acquired pneumonia

A

within 5 days: co-amoxiclav or cefuroxime

more than 5 days: piperacillin with tazobactam

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17
Q

First line antibiotics for acute pyelonephritis

A

Broad spectrum cephalosporin (ceftriaxone)

or quinolone (ciprofloxacin)

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18
Q

First line antibiotics for acute prostatitis

A

quinolone (ciprofloxacin)

or trimethoprim

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19
Q

First line antibiotic for impetigo

A

Topical hydrogen peroxide

Oral fluclox or erythromycin if widespread

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20
Q

First line antibiotic for cellulitis near the eyes or nose

First line if pen allergic

A

Co-amoxiclav

Pen allergic: clarithromycin + metronidazole

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21
Q

First line antibiotic for erysipelas

First line if pen allergic

A

Flucloxacillin

Pen allergic: clari, erythromycin or doxycycline

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22
Q

First line antibiotic for animal or human bite

First line if pen allergic

A

Co-amoxiclav

Pen allergic: doxy + metronidazole

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23
Q

First line antibiotic for mastitis during breast feeding

A

Flucloxacillin

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24
Q

First line antibiotic for sinusitis

First line if pen allergic

A

Phenoxymethylpenicillin

Pen allergic: doxy or clari

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25
Q

First line antibiotic for otitis media

first line if pen allergic

A

Amoxicillin

Pen allergic: erythromycin

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26
Q

First line antibiotic for otitis externa

First line if pen allergic

A

Flucloxacillin

Pen allergic: erythromycin

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27
Q

First line antibiotic for periapical or periodontal abscess

A

Amoxicillin

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28
Q

First line antibiotic for gingivitis

A

Metronidazole

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29
Q

First line antibiotic for gonorrhoea

A

IM ceftriaxone

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30
Q

First line antibiotic for chlamydia

A

Doxycycline or azithromyin

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31
Q

First line antibiotic for pelvic inflammatory disease

A

Oral ofloxacin + oral metronidazole

OR

IM ceftriaxone + oral doxycycline + oral metronidazole

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32
Q

First line antibiotic for syphilis

A

Benzathine benzylpenicillin

or doxycycline
or erythromycin

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33
Q

First line antibiotic for bacterial vaginosis

A

oral or topical metronidazole

or topical clindamycin

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34
Q

Antibiotic for clostridium difficile

A

metronidazole

2nd/subsequent infecitons: vancomycin

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35
Q

First line antibiotic for campylobacter enteritis

A

Clarithromycin

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36
Q

First line antibiotic for salmonella (non-typhoid)

A

Ciprofloxacin

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37
Q

First line antibiotic for shigellosis

A

Ciprofloxacin

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38
Q

Splenectomy - vaccination

A

2 weeks prior to op - Hib, meningitis A and C

annual influenza

pneumococcal every 5 years

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39
Q

Splenectomy - antibiotic prophylaxis

A

Penicillin V

usually for life
at least 2 years

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40
Q

Post-splenectomy changes

A

Platelets rise first
Blood film changes with Howell-Jolly bodies, target cells
Risk of post-splenectomy sepsis

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41
Q

Complications of splenectomy

A

Haemorrhage
Pancreatic fistula
Thrombocytosis
Encapsulated bacterial infection

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42
Q

Which bacteria are post-splenectomy patients particularly prone to?

A

Strep pneumoniae

Haemophilius influenzae

Nisseria meningitidis

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43
Q

Most common cause of travellers diarrhoea

A

Escherichia coli

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44
Q

Common causes of acute food poisoning

A

Staphylococcus aureus

Bacillus cereus

Clostridium perfrigens

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45
Q

Typical history from giardiasis

A

Prolonged non-bloody diarrhoea

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46
Q

Typically history from cholera

A

Profuse, watery diarrhoea

Severe dehydration and weight loss

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47
Q

Typical history from shigella

A

Bloody diarrhoea

Vomiting, abdo pain

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48
Q

Typical history from staphylococcus aureus gastroenteritis

A

Severe vomiting

Short incubation period

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49
Q

Typical history from campylobacter

A

Flu like prodrome

Crampy abdo pain, fever

Diarrhoea may be bloody

May mimic appendicitis

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50
Q

Typical history from bacillus cereus gastroenteritis

A

Vomiting within 6 hours due to rice

OR diarrhoea after 6 hours

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51
Q

Typical history from amoebiasis gastroenteritis

A

Gradual onset bloody diarrhoea
Abdo pain
May last several weeks

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52
Q

Transmission risk of Hep B from a needle stick injury

A

20-30%

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53
Q

Transmission risk of Hep C from a needle stick injury

A

0.5-2%

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54
Q

Transmission risk of HIV from a needle stick injury

A

0.3%

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55
Q

Post exposure prophylaxis for Hep A

A

Human Normal Immunoglobulin

Or Hep A vaccine

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56
Q

Post exposure prophylaxis for Hep B

A

Booster vaccine if known responder

If non-responder then hep B immunoglobulin and vaccine

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57
Q

Post exposure prophylaxis for hep C

A

Monthly PCR

If seroconversation then interferon +/- ribavirin

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58
Q

Post exposure prophylaxis for HIV

A

High risk: oral antiretrovirals for 4 weeks

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59
Q

Post exposure prophylaxis for varicella zoster

A

VZIG

If IgG negative and pregnant or immunosuppressed

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60
Q

Live attenuated vaccines

A

BCG

MMR

Oral polio

Yellow fever

Oral typhoid

Intranasal influenza

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61
Q

Inactivated preparations of vaccines

A

Rabies

Hepatitis A

Intramuscular influenza

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62
Q

Inactivated toxin vaccines

A

Tetanus

Diphtheria

Pertussis

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63
Q

Hepatitis E during pregnancy

A

20% mortality

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64
Q

Where is hepatitis E often transmitted from?

A

Shellfish

Pork

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65
Q

What cancers are linked to HPV?

A

Cervical cancers - >99%
Anal cancers - 85%
Vulval and vaginal cancers - 50%
Mouth and throat cancers - 20-30%

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66
Q

Which HPV vaccine is used and what does it protect against?

A

Gardasil

HPV 6, 11, 16 and 18

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67
Q

When is HPV vaccine given?

A

12 and 13 year old boys and girls in year 8

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68
Q

How many doses is the HPV vaccine?

A

2

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69
Q

What is the standard fridge temperature for storing vaccines?

A

+2 to +8 degrees C

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70
Q

Classical features of pneumocystis jiroveci

A

Pneumonia in HIV patients
Few chest signs
Exertional dyspnoea

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71
Q

Classical features of legionella pneumophilia

A

Spread by air conditioning

Dry cough

Lymphopenia

Deranged LFTs

Hyponatraemia

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72
Q

Classical features of mycoplasma pneumoniae

A

Flu like symptoms precede dry cough

Haemolytic anaemia

Erythema multiforme

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73
Q

Which organism causes pneumonia after influenza?

A

Staphylococcus aureus

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74
Q

Most common cause of community acquired pneumonia

A

Streptococcus pneumoniae

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75
Q

Most common cause of bronchiolitis

A

respiratory syncytial virus

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76
Q

Who should be screened for MRSA?

A

All admissions except termination of pregnancy, ophthalmic surgery, mental health

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77
Q

How should a patient be screened for MRSA?

A

Nasal swab and skin lesions

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78
Q

How to treat MRSA once found

A

Nose - mupirocin 2% TDS for 5 days

Skin - chlorhexidine OD for 5 days

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79
Q

Antibiotics commonly used to treat MRSA

A

Vancomycin

Teicoplanin

Linezolid

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80
Q

Which antibiotic to use for cellulitis in a pregnant woman allergic to penicillin?

A

Erythromycin

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81
Q

Should patients with asthma get the pneumococcal vaccine?

A

Only if need regular or long term prednisolone

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82
Q

Antibiotic for cellulitis if allergic to penicillin

A

Clarithromycin

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83
Q

Antibiotic for animal bites

A

Co-amoxiclav

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84
Q

Antibiotic for animal bite if penicillin allergic

A

Doxycycline + metronidazole

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85
Q

Presentation of Kaposi’s sarcoma

A

Purple papules or plaques that may ulcerate

Respiratory involvement causing massive haemoptysis and pleural effusion

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86
Q

Cause of Kaposi’s sarcoma

A

Human herpes virus 8

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87
Q

Cause of croup

A

Parainfluenza virus

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88
Q

Features of Orf

A

Affects hands and arms

Small, raised red-blue papules

May increase to 2-3cm and become flat-topped and haemorrhagic

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89
Q

Empirical therapy for meningitis age <3 months

A

IV cefotaxime + amoxicllin

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90
Q

Empircal therapy for meningitis age 3 months - 50 years

A

IV cefotaxime

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91
Q

Empircal therapy for meningitis >50 years

A

IV cefotaxime + amoxicillin

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92
Q

Antibiotic choice for meningococcal meningitis

A

IV benzyl penicillin or cefotaxime

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93
Q

Antibiotic choice for pneumococcal meningitis

A

IV cefotaxime

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94
Q

Antibiotic choice for meningitis caused by haemophilus influenzae

A

IV cefotaxime

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95
Q

Antibiotic choice for meningitis caused by listera

A

IV amoxicillin + gentamicin

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96
Q

Prophylactic antibiotic choice for close contacts of patients with meningitis

A

Oral ciprofloxacin (one dose)

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97
Q

When are close contacts of patients with meningitis at highest risk?

A

first 7 days

Risk persists for 4 weeks

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98
Q

Which antibiotic to give to treat UTI in a pregnant women at or near term?

A

Cefalexin or amoxicillin for 7 days

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99
Q

Risk of giving nitrofurantoin to a pregnant women at term

A

May induce haemolysis in the newborn

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100
Q

Vaccinations for patients with CKD including dialysis

A

Pneumococcus

Influenza

Hepatitis B

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101
Q

Classical features in Behcet’s disease

A

Oral ulcers
Genital ulcers
Uveitis

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102
Q

When to send a urine culture in UTI for non-pregnant women?

A

age >65

visible or non-visible haematuria

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103
Q

Age of first influenza vaccine

A

2-3 years

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104
Q

How many doses of tetanus are in the routine schedule?

A

5

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105
Q

What is a tetanus prone wound?

A

Puncture type injuries in contaminated environment e.g. gardening

Wounds with foreign bodies

Compound fractures

Wounds or burns with systemic sepsis

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106
Q

Tetanus prevention when patient has had full course of tetanus vaccines with last dose <10 years ago

A

No vaccine or immunoglobulin regardless of wound severity

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107
Q

Tetanus prevention when a patient has had a full course of tetanus vaccines with last dose >10 years ago

A

Tetanus prone wound = reinforcing dose of vaccine

High risk wounds = reinforcing dose of vaccine + tetanus immunogloublin

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108
Q

Tetanus prevention when vaccination history is unknown or incomplete

A

Reinforcing dose of vaccine regardless of wound severity

Tetanus prone and high risk wounds = reinforcing dose of vaccine + tetanus immunoglobulin

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109
Q

Which patient groups should have the pneumococcal vaccine every 5 years?

A

Splenectomy

CKD

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110
Q

Malignancies associated with EBV

A

Burkitt’s lymphoma
Hodgkin’s lymphoma
Nasopharyngeal carcinoma
HIV associated CNS lymphoma

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111
Q

What aged children get the influenza vaccine?

A

2 to 10 years

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112
Q

Treatment of pubic lice

A

Malathion lotion or permethrin cream

Need to reapply after 7 days

113
Q

Who gets the pneumococcal conjugate vaccine?

A

Children

114
Q

Who gets the pneumococcal polysaccharide vaccine?

A

Adults

115
Q

Which causes of gastroenteritis have incubation periods over 7 days?

A

Giardiasis

Amoebiasis

116
Q

Should asthmatics get the annual influenza vaccine?

A

Only if need steroid inhaler

117
Q

Causes of painless genital ulcers

A

Syphilis

Lymphogranuloma venereum

118
Q

Causes of painful genital ulcers

A

Behcets
Herpes simplex
Chancroid

119
Q

Antibiotic for cellulitis near the eyes

A

Co-amoxiclav

120
Q

Antibiotic for cellulitis in pregnancy

A

Erythromycin

as you can’t have clarithromycin during pregnancy

121
Q

Features of catch scratch disease

A

Fever

History of cat scratch

Regional lymphadenopathy

Headache, malaise

122
Q

Cutaneous larva migrans - features and treatment

A

Infection of dog hookworm

Itchy, creeping rash

Treatment: albendazole or ivermectin

123
Q

Bed bugs management

A

Hot wash all clothes and bedding
Topical hydrocortisone for itching
Need pest management for house

124
Q

What chemical to use for cleaning bodily fluids?

A

Hypochlorite

125
Q

Giardiasis - presentation

A 
Often asymptomatic
Lethargy, bloating, abdo pain
Flatulence
Non-bloody diarrhoea
Chronic diarrhoea, malabsorption, lactose intolerance
126
Q

Giardiasis - treatment

A

metronidazole

127
Q

Giardiasis - diagnosis

A

Stool microscopy often negative

Need duodenal fluid aspirates or ‘string tests’

128
Q

Malaria prophylaxis in pregnancy

A

Chloroquine

If taking proguanil need folate 5mg OD

129
Q

Malarone side effects

A

GI upset

130
Q

Malarone timing

A

1-2 days before travel

7 days after travel

131
Q

Chloroquine side effects

A

Headache

132
Q

Chloroquine contraindications

A

Epilepsy

133
Q

Chloroquine - how often is it taken?

A

weekly

134
Q

Chloroquine timing

A

1 week before travel

4 weeks after travel

135
Q

Doxycycline side effects

A

Photosensitivity

Oesophagitis

136
Q

Doxycycline timings as malaria prophylaxis

A

1-2 days before travel

4 weeks after travel

137
Q

Mefloquine side effects

A

dizziniess

neuropsychiatric disturbance

138
Q

Mefloquine timings

A

2-3 weeks before travel

4 weeks after travel

139
Q

Proguanil timings

A

1 week before travel

4 weeks after travel

140
Q

Proguanil + chloroquine timings

A

1 week before travel

4 weeks after travel

141
Q

Deet usage in malaria areas

A

20-50% deet repels up to 100% mosquitoes

142
Q

What aged can you start using DEET?

A

over 2 months

143
Q

Treatment of malaria

A

If chloroquine sensitive area = artemisinin-based combination therapy (ACT) or chloroquine

If chloroquine resistant area = ACT

144
Q

Treatment of malaria in pregnancy

A

Can’t have ACT

Use chloroquine

145
Q

What additional treatment should be given to patients with ovale or vivax malaria?

A

Primaquine

destroys liver hypnozoites to prevent relapse

146
Q

Metronidazole - side effects

A

Disulfiram-like reaction with alcohol

147
Q

What is non-gonococcal urethritis?

A

urethral discharge and dysuria, but swab doesn’t show any gram negative diplococci

148
Q

Causes of non-gonococcal urethritis

A

Chlamydia trachomatis

Mycoplasma genitalium

149
Q

Treatment of non-gonococcal urethritis

A

Contact tracting

Oral azithromycin or doxycycline

150
Q

Type of pneumonia classical in alcoholics

A

Klebsiella pneumoniae

151
Q

What is strongyloidiasis caused by?

A

Parasitic worm

152
Q

Features of strongyloidiasis

A

Diarrhoea
Abdominal pain/bloating
Papulovesicular lesions where skin has been penetrated by larve e.g. soles of feet, buttocks
Larva currens - a pruritic linear rash

153
Q

Most common cause of diarrhoea in HIV patients

A

Cryptosporidium

154
Q

Examples of cephalosporins

A

Cefotaxime

Ceftriaxone

Cefalexin

155
Q

Examples of quinolones

A

Ciprofloxacin

Levofloxacin

156
Q

Antibiotic to be used in gonorrhoea if won’t have injection

A

oral cefixime + oral azithromycin

157
Q

Most common cause of infective exacerbation of COPD

A

Haemophilus influenzae

158
Q

Two most common causes of otitis externa

A

1) Pseudomonas aeruginosa

2) Staphylococcus aureus

159
Q

Lymphogranuloma venereum - features

A

Painless ulcer on vagina, penis or anus

Lymphadenopathy

160
Q

Lymphogranuloma venerum - cause

A

Chlamydia trachomatis

161
Q

Lymphogranuloma venerum - treatment

A

Doxycycline

162
Q

Trichomonas vaginalis - features

A

Offensive yellow frothy discharge
Vulvovaginitis
Strawberry cervix
pH >4.5

163
Q

Trichomonas vaginalis - investigations

A

Microscopy shows motile trophozoites

164
Q

Trichomonas vaginalis - management

A

Oral metronidazole for 5-7 days

Or 2g metronidazole one off

165
Q

What spreads African Trypanosomiasis?

A

Tsete fly

166
Q

African trypanosomiasis - features

A

Chancre - painless nodule at infection site

Intermittent fever

Enlarged posterior cervical lymph nodes

CNS involvement leads to somnolence, headache, low mood, meningoencephalitis

167
Q

American trypanosomiasis is also called what?

A

Chaga’s disease

168
Q

American trypanosomiasis - chronic features

A

Myocarditis causing dilated cardiomyopathy

Megaoesophagus causing dysphagia

Megacolon causing constipation

169
Q

Initial management of active TB duration

A

2 months

170
Q

Initial management of active TB drugs

A

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

171
Q

What medication needs to be taken with isoniazid?

A

Pyridoxine (B6) to prevent peripheral neuropathy

172
Q

Side effects of rifampicin

A

Liver enzyme inducer
Hepatitis
Orange secretions
Flu like symptoms

173
Q

Side effects of isonidazide

A

Peripheral neuropathy (give pyridoxine)
Hepatitis
Agranulocytosis
Liver enzyme inhibitor

174
Q

Side effects of pyrazinamide

A

Hyperuricaemia causing gout
Arthralgia
Mylagia
Hepatitis

175
Q

Side effects of ethambutol

A

Optic neuritis so check visual acuity before and during treatment

176
Q

Continuation phase of treating active TB duration

A

4 months

177
Q

Drugs used in continuation phase of treating active TB

A

Rifampicin

Isoniazid

178
Q

Treatment for latent TB

A

3 months of isonidazid (+pyridoxine) and rifampicin

OR

6 months of isoniazid (+pyridoxine)

179
Q

Treatment of meningeal TB

A

Treat for 12 months

Add steroids

180
Q

Symptoms of Zika virus

A 
mild febrile illness for 2-7 days
arthralgia
rash
conjunctivitis
retroorbital pain
pruritis
181
Q

Zika virus and pregnancy

A

Risk of microcephaly and congenital defects

Avoid pregnancy for 8 weeks after travelling to endemic area

182
Q

Tests used to diagnose HIV

A

Combination test for HIV antibodies and p24 antigen

Repeat if positive

183
Q

When to test for HIV in asymptomatic people who have come into contact?

A

4 weeks

If negative repeat at 12 weeks

184
Q

When are HIV antibodies positive?

A

99% positive at 3 months

Majority by 4 weeks

185
Q

When are p24 antigen positive in testing for HIV?

A

Between week 1 and week 4

186
Q

Features of HIV seroconversion

A 
Sore throat 
Lymphadenopathy
Diarrhoea
Maculopapular rash
Mouth ulcers
187
Q

Toxoplasmosis - features

A

Constitutional symptoms
Headache
Confusion
Drowsy

188
Q

Toxoplasmosis - findings on CT

A

Single or multiple ring enhancing lesions, may have mass effect

Thallium SPECT negative

189
Q

Cryptococcus - findings on CT

A

meningeal enhancement

cerebral oedema

190
Q

Cryptococcus in HIV patients - features

A

Headache
Fever
N+V

Seizures
Focal neurology

High opening pressure on LP
CSF india ink positive

191
Q

What is progressive multifocal leukoencephalopathy?

A

Widespread demyelination in HIV patients due to JC virus

192
Q

Primary CNS lymphoma - CT findings

A

Single or multiple solid (homogenous) enhancing lesions

Thallium SPECT positive

193
Q

Cause of syphilis

A

Trepnonema pallidum

194
Q

Primary syphilis

A

Chancre - painless ulcer
Local non-tender lymphadenopathy

In women lesion may be on cervix

195
Q

Secondary syphilis

A

6-10 weeks later

Fevers, lymphadenopathy
Rash
Buccal “snail track” ulcers
Condylomata lata (painless warty lesions on genitals)

196
Q

Tertiary syphilis

A

Gummas (granulomatous lesions on skin and bones)
Ascending aortic aneuryms
General paralysis of the insane
Argyll-Robertson pupil

197
Q

Congenital syphilis

A 
Hutchinsons teeth "mulberry molars"
Rhagades (linear scars at angle of mouth)
Keratitis
Saddle nose
Deafness
198
Q

Rubella - features

A

Low grade fever
Maculopapular rash, starts on face then spreads to body
Lymphadenopathy

199
Q

Mumps - features

A

Fever
Malaise, muscle aches
Parotitis

200
Q

Mumps - complications

A

Orchitis in 35% post pubertal males
Hearing loss - unilateral, transient
Meningoencephalitis
Pancreatitis

201
Q

Mumps - vaccine efficacy

A

MMR vaccine 80% effective

202
Q

Mumps - management

A

Supportive

Notifiable disease

203
Q

Legionella - features

A 
Flu like symptoms, fever
Dry cough
Relative bradycardia
Confusion
Lymphopenia
Hyponatraemia
Deranged LFTs
Pleural effusion
204
Q

Legionella - diagnosis

A

Urinary antigen

205
Q

Legionella - management

A

Erythromycin or clarithromycin

206
Q

Hepatitis A - spread

A

Faecal oral

207
Q

Hepatitis A - features

A 
Flu like prodrome
RUQ pain
tender hepatomegaly
Jaundice
Cholestatic LFTs
208
Q

Who should be vaccinated against Hep A?

A 
Travelling or living in high prevalence area and >1year old
Chronic liver disease
Haemophilia
Men who have sex with men
IVDU
Occupational risk
209
Q

Hepatitis B - spread

A

Exposure to infected blood or body fluids

Vertical transmission

210
Q

Hepatitis B - features

A

Fever
Jaundice
Elevated liver transaminases

211
Q

Hepatitis B - complications

A 
Chronic hepatitis
Fuliment liver failure
HCC
Glomerulonephritis
Polyarteritis nodosa
Cryoglobulinaemia
212
Q

Hepatitis B - management

A

Pegylated interferon alpha

213
Q

What is considered a good response to hep B vaccine?

A

Anti-HBs >100

214
Q

What is considered a suboptimal response to hep B vaccine and what are the next steps?

A

Anti-HBs 10-100

1x further vaccine dose

215
Q

What is considered a non-responder to hep B vaccine and what are the next steps?

A

<10

Test for current or past infection
Further full 3x vaccine course then test again
If still no response then needs HBIG if exposed to virus

216
Q

Hepatitis C - features

A

70% asymptomatic
Jaundice
Fatigue
Transient rise in aminotransferase

217
Q

Hepatitis C - investigations

A

HCV RNA for acute infection

Anti-HCV antibodies (these will remain in patients who spontaneously clear the virus)

218
Q

Hepatitis C - what % will clear the acute infection?

A

15-45%

219
Q

What is defined as chronic hepatitis C?

A

Persistence of HCV RNA in the blood for 6 months

220
Q

Complications of chronic hepatitis C

A 
sjogren's syndrome
arthritis
cirrhosis
HCC
cryoglobulinaemia
porphyria cutanea tarda
glomerulonephritis
221
Q

Chronic hepatitis C - management

A

Protease inhibitors +/0 ribaviran

222
Q

Chronic hepatitis C - with treatment what % clear the virus?

A

95%

223
Q

Ribavirin side effects

A

Haemolytic anaemia

Cough

Teratogenic - can’t get pregnant for 6 months after

224
Q

What is ribavirin used for?

A

Chronic hepatitis C

225
Q

Which virus does hepatitis D need to exist?

A

Hep B

226
Q

Hepatitis D - co-infection definition

A

Hepatitis B and hepatitis D infection at the same time

227
Q

Hepatitis D - superinfection definition

A

Hepatitis B surface antigen positive patient subsequently develops hep D

228
Q

What are the risks of hepatitis D superinfection?

A

Fulminant hepatitis
Chronic hepatitis status
Cirrhosis

229
Q

How is leptospirosis spread?

A

Infected rat urine

at risk are sewage workers, farmers, vets, abattoir workers

230
Q

Leptospirosis - symptoms

A

Fever, flu like symptoms
Subconjunctival haemorrhage

Later stages:
AKI
Hepatitis with jaundice and hepatomegaly
Aseptic meningitis

231
Q

Leptospirosis - investigations

A

Serology - antibodies

232
Q

Leptospirosis - management

A

high dose benzylpenicillin or doxycycline

233
Q

Brucellosis - features

A

Fever

Hepatosplenomegaly

Sacroiliitis

Leukopenia

234
Q

Brucellosis - diagnosis

A

rose bengal test for screening

brucella serology

235
Q

Brucellosis - management

A

doxycycline and streptomycin

236
Q

Dengue fever - complications

A

Viral haemorrhagic fever causing dengue shock syndrome

237
Q

Dengue fever - presentation

A

Headache
Fever
Myalgia

Pleuritic pain

Facial flushes

Maculopapular rash

238
Q

Infectious mononucleosis - features

A 
Sore throat
Lymphadenopathy
Pyrexia
Splenomegaly
Palatal petechiae
239
Q

Infectious mononucleosis - diagnosis

A

Monospot test aka heterophil antibody test

240
Q

Infectious mononucleosis and sport

A

Avoid contact sports for 8 weeks due to risk of splenic rupture

241
Q

Lyme disease - cause

A

Borrelia burgdorferi

spread by tics

242
Q

Lyme disease - early features

A 
Erythema chronicum migrans - bulls eye rash at bite site 1-4 weeks later
Headache
Lethargy
Fever
Arthralgia
243
Q

Lyme disease - late features

A

Cardio = heart block, peri/myocarditis

Neuro = facial nerve palsy, radicular pain, meningitis

244
Q

Lyme disease - investigations

A

Clinical diagnosis if erythema migrans present

ELIZA
Immunoblot test

245
Q

Lyme disease - management in early disease

Management in pregnancy

A

Doxycycline

if C/I (eg pregnant) then amoxicillin

246
Q

Lyme disease - management in disseminated disease

A

Ceftriaxone

247
Q

Gonorrhoea - cause

A

Neisseria gonorrhoeae

248
Q

Gonorrhoea - features

A

Men: Urethral discharge, dysuria

Women: Cervicitis

249
Q

Gonorrhoea - management

A

IM ceftriaxone 1g stat + oral azithromycin 1g

IF SENSITIVITIES KNOWN then stat dose oral cipro 500mg

250
Q

Chlamydia - cause

A

Chlamydia trachomatis

251
Q

Chlamydia - features

A

Women: Cervicitis, dysuria

Men: urethral discharge, dysuria

252
Q

What % of women with chlamydia are asymptomatic?

A

70%

253
Q

What % of men with chlamydia are asymptomatic?

A

50%

254
Q

Chlamydia - investigations

A

NAAT (nuclear acid amplification test)

Urine, vulvovaginal or cervical swab

2 weeks after exposure

255
Q

Chlamydia - management

Management if pregnant

A

Doxycycline for 7 days

If C/I (eg pregnant) then azithromycin 1g OD for 1 day or 500mg OD for 2 days

256
Q

Chlamydia - partner notification for symptomatic men

A

All contacts since symptoms started and 4 weeks before

257
Q

Chlamydia - partner notification for women and asymptomatic men

A

All contacts for the last 6 months and most recent sexual partner

258
Q

Chlamydia - antibiotic in pregnancy

A

Azithromycin

259
Q

Campylobacter - features

A

Prodrome of headache, malaise
Bloody diarrhoea
Abdo pain
May mimic appendicitis

260
Q

Campylobacter - management

A

Treat if severe or immunocompromised

1st line: clarithromycin
2nd line: ciprofloxacin

261
Q

Campylobacter - complications

A

Guillian-Barre

Reactive arthritis

Septicaemia

Endocarditis

262
Q

Herpes simplex virus - management of gingivostomatitis

A

Oral aciclovir

Chlorhexidine mouthwash

263
Q

Herpes simplex virus - management in pregnancy

A

Elective section if primary attack >28 weeks

If recurrent herpes then suppressive therapy

264
Q

What is bacterial vaginosis?

A

Overgrowth of anaerobic organisms causing fall in anaerobic lactobacilli which raises pH

265
Q

Bacterial vaginosis - features

A

Asymptomatic in 50%
Discharge is fishy, thin, white
vaginal pH >4.5

266
Q

Bacterial vaginosis - microscopy

A

Clue cells

267
Q

Bacterial vaginosis - risks to pregnancy

A

Preterm labour

Low birth weight

Chorioamnionitis

Late miscarriage

268
Q

Bacterial vaginosis - management in pregnancy

A

Oral metronidazole

269
Q

Bacterial vaginosis - management

A

Oral metronidazole

70% initial cure but >50% relapse

270
Q

What is Leishmaniasis spread by?

A

sand fly bites

271
Q

Cutaneous Leishmaniasis

A

Crusted lesion at site of bite

272
Q

Mucocutaneous leischmaniasis

A

Skin lesions spread to involve mucosae of nose, pharynx, etc

273
Q

Visceral leischmaniasis - features

A

Fever, sweats

Massive splenomegaly, hepatomegaly

Grey skin

Pancytopenic secondary to hypersplenism

274
Q

What is enteric fever also called?

A

Typhoid and paratyphoid

275
Q

Enteric fever - features

A

Fever, headache

Relative bradycardia

Abdo pain and abdo distension

Constipation

Rose spots on trunk

276
Q

Enteric fever - complications

A

Osteomyelitis

GI bleed or perf

Meningitis

Cholecystitis

Chronic carriage

277
Q

Mycoplasma pneumoniae - features

A 
Gradual onset, flu like symptoms
COld agglutins cause haemolytic anaemia 
Erythema multiform or erythema nodosom
Meningoencephalitis
Pericarditis
Hepatitis
Glomerulonephritis
278
Q

Mycoplasma pneumoniae - diagnosis

A

Mycoplasma serology

Positive cold agglutination test

AKT (20 decks)

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