Infectious diseases Flashcards
1
Q
Which pneumonia is associated with erythema multiforme?
A
Mycoplasma pneumoniae
2
Q
Treatment for invasive diarrhoea
A
Ciprofloxacin
3
Q
First line treatment for UTI in pregnant women
A
Nitrofurantoin (avoid if near term)
4
Q
Second line treatment for UTI in pregnant women
A
Amoxicillin or cefalexin
5
Q
Treatment of UTI in men
A
7 days trimethoprim or nitrofurantoin
6
Q
Management of cellulitis
A
Flucloxacillin
If pen allergic: clarithromycin, erythromycin or doxycycline
Pen allergic + pregnant: erythromycin
7
Q
Causes of genital warts
A
HPV 6 and 11
8
Q
Causes of cervical cancer
A
HPV 16, 18 and 33
9
Q
Treatment of genital warts
A
Topical podophyllum
Cryotherapy
Imiquimod 2nd line
10
Q
What causes a chancroid?
A
Haemophilus ducreyi
11
Q
What does haemophilius ducreyi cause?
A
Chancroid
12
Q
Chancroid features
A
Painful genital ulcers with unilateral, painful inguinal lymph node enlargement
13
Q
First line antibiotic for uncomplicated pneumonia
First line if pen allergic
A
amoxicillin
Pen allergic: doxycycline, clarithromycin
14
Q
What should you add if you suspect pneumonia is secondary to influenza?
A
Flucloxacillin
15
Q
First line antibiotic for atypical pneumonia
A
Clarithromycin
16
Q
First line antibiotic for hospital acquired pneumonia
A
within 5 days: co-amoxiclav or cefuroxime
more than 5 days: piperacillin with tazobactam
17
Q
First line antibiotics for acute pyelonephritis
A
Broad spectrum cephalosporin (ceftriaxone)
or quinolone (ciprofloxacin)
18
Q
First line antibiotics for acute prostatitis
A
quinolone (ciprofloxacin)
or trimethoprim
19
Q
First line antibiotic for impetigo
A
Topical hydrogen peroxide
Oral fluclox or erythromycin if widespread
20
Q
First line antibiotic for cellulitis near the eyes or nose
First line if pen allergic
A
Co-amoxiclav
Pen allergic: clarithromycin + metronidazole
21
Q
First line antibiotic for erysipelas
First line if pen allergic
A
Flucloxacillin
Pen allergic: clari, erythromycin or doxycycline
22
Q
First line antibiotic for animal or human bite
First line if pen allergic
A
Co-amoxiclav
Pen allergic: doxy + metronidazole
23
Q
First line antibiotic for mastitis during breast feeding
A
Flucloxacillin
24
Q
First line antibiotic for sinusitis
First line if pen allergic
A
Phenoxymethylpenicillin
Pen allergic: doxy or clari
25
First line antibiotic for otitis media
first line if pen allergic
Amoxicillin
Pen allergic: erythromycin
26
First line antibiotic for otitis externa
First line if pen allergic
Flucloxacillin
Pen allergic: erythromycin
27
First line antibiotic for periapical or periodontal abscess
Amoxicillin
28
First line antibiotic for gingivitis
Metronidazole
29
First line antibiotic for gonorrhoea
IM ceftriaxone
30
First line antibiotic for chlamydia
Doxycycline or azithromyin
31
First line antibiotic for pelvic inflammatory disease
Oral ofloxacin + oral metronidazole
OR
IM ceftriaxone + oral doxycycline + oral metronidazole
32
First line antibiotic for syphilis
Benzathine benzylpenicillin
or doxycycline
or erythromycin
33
First line antibiotic for bacterial vaginosis
oral or topical metronidazole
or topical clindamycin
34
Antibiotic for clostridium difficile
metronidazole
2nd/subsequent infecitons: vancomycin
35
First line antibiotic for campylobacter enteritis
Clarithromycin
36
First line antibiotic for salmonella (non-typhoid)
Ciprofloxacin
37
First line antibiotic for shigellosis
Ciprofloxacin
38
Splenectomy - vaccination
2 weeks prior to op - Hib, meningitis A and C
annual influenza
pneumococcal every 5 years
39
Splenectomy - antibiotic prophylaxis
Penicillin V
usually for life
at least 2 years
40
Post-splenectomy changes
Platelets rise first
Blood film changes with Howell-Jolly bodies, target cells
Risk of post-splenectomy sepsis
41
Complications of splenectomy
Haemorrhage
Pancreatic fistula
Thrombocytosis
Encapsulated bacterial infection
42
Which bacteria are post-splenectomy patients particularly prone to?
Strep pneumoniae
Haemophilius influenzae
Nisseria meningitidis
43
Most common cause of travellers diarrhoea
Escherichia coli
44
Common causes of acute food poisoning
Staphylococcus aureus
Bacillus cereus
Clostridium perfrigens
45
Typical history from giardiasis
Prolonged non-bloody diarrhoea
46
Typically history from cholera
Profuse, watery diarrhoea
| Severe dehydration and weight loss
47
Typical history from shigella
Bloody diarrhoea
| Vomiting, abdo pain
48
Typical history from staphylococcus aureus gastroenteritis
Severe vomiting
| Short incubation period
49
Typical history from campylobacter
Flu like prodrome
Crampy abdo pain, fever
Diarrhoea may be bloody
May mimic appendicitis
50
Typical history from bacillus cereus gastroenteritis
Vomiting within 6 hours due to rice
| OR diarrhoea after 6 hours
51
Typical history from amoebiasis gastroenteritis
Gradual onset bloody diarrhoea
Abdo pain
May last several weeks
52
Transmission risk of Hep B from a needle stick injury
20-30%
53
Transmission risk of Hep C from a needle stick injury
0.5-2%
54
Transmission risk of HIV from a needle stick injury
0.3%
55
Post exposure prophylaxis for Hep A
Human Normal Immunoglobulin
Or Hep A vaccine
56
Post exposure prophylaxis for Hep B
Booster vaccine if known responder
If non-responder then hep B immunoglobulin and vaccine
57
Post exposure prophylaxis for hep C
Monthly PCR
If seroconversation then interferon +/- ribavirin
58
Post exposure prophylaxis for HIV
High risk: oral antiretrovirals for 4 weeks
59
Post exposure prophylaxis for varicella zoster
VZIG
If IgG negative and pregnant or immunosuppressed
60
Live attenuated vaccines
BCG
MMR
Oral polio
Yellow fever
Oral typhoid
Intranasal influenza
61
Inactivated preparations of vaccines
Rabies
Hepatitis A
Intramuscular influenza
62
Inactivated toxin vaccines
Tetanus
Diphtheria
Pertussis
63
Hepatitis E during pregnancy
20% mortality
64
Where is hepatitis E often transmitted from?
Shellfish
| Pork
65
What cancers are linked to HPV?
Cervical cancers - >99%
Anal cancers - 85%
Vulval and vaginal cancers - 50%
Mouth and throat cancers - 20-30%
66
Which HPV vaccine is used and what does it protect against?
Gardasil
HPV 6, 11, 16 and 18
67
When is HPV vaccine given?
12 and 13 year old boys and girls in year 8
68
How many doses is the HPV vaccine?
2
69
What is the standard fridge temperature for storing vaccines?
+2 to +8 degrees C
70
Classical features of pneumocystis jiroveci
Pneumonia in HIV patients
Few chest signs
Exertional dyspnoea
71
Classical features of legionella pneumophilia
Spread by air conditioning
Dry cough
Lymphopenia
Deranged LFTs
Hyponatraemia
72
Classical features of mycoplasma pneumoniae
Flu like symptoms precede dry cough
Haemolytic anaemia
Erythema multiforme
73
Which organism causes pneumonia after influenza?
Staphylococcus aureus
74
Most common cause of community acquired pneumonia
Streptococcus pneumoniae
75
Most common cause of bronchiolitis
respiratory syncytial virus
76
Who should be screened for MRSA?
All admissions except termination of pregnancy, ophthalmic surgery, mental health
77
How should a patient be screened for MRSA?
Nasal swab and skin lesions
78
How to treat MRSA once found
Nose - mupirocin 2% TDS for 5 days
Skin - chlorhexidine OD for 5 days
79
Antibiotics commonly used to treat MRSA
Vancomycin
Teicoplanin
Linezolid
80
Which antibiotic to use for cellulitis in a pregnant woman allergic to penicillin?
Erythromycin
81
Should patients with asthma get the pneumococcal vaccine?
Only if need regular or long term prednisolone
82
Antibiotic for cellulitis if allergic to penicillin
Clarithromycin
83
Antibiotic for animal bites
Co-amoxiclav
84
Antibiotic for animal bite if penicillin allergic
Doxycycline + metronidazole
85
Presentation of Kaposi's sarcoma
Purple papules or plaques that may ulcerate
| Respiratory involvement causing massive haemoptysis and pleural effusion
86
Cause of Kaposi's sarcoma
Human herpes virus 8
87
Cause of croup
Parainfluenza virus
88
Features of Orf
Affects hands and arms
Small, raised red-blue papules
May increase to 2-3cm and become flat-topped and haemorrhagic
89
Empirical therapy for meningitis age <3 months
IV cefotaxime + amoxicllin
90
Empircal therapy for meningitis age 3 months - 50 years
IV cefotaxime
91
Empircal therapy for meningitis >50 years
IV cefotaxime + amoxicillin
92
Antibiotic choice for meningococcal meningitis
IV benzyl penicillin or cefotaxime
93
Antibiotic choice for pneumococcal meningitis
IV cefotaxime
94
Antibiotic choice for meningitis caused by haemophilus influenzae
IV cefotaxime
95
Antibiotic choice for meningitis caused by listera
IV amoxicillin + gentamicin
96
Prophylactic antibiotic choice for close contacts of patients with meningitis
Oral ciprofloxacin (one dose)
97
When are close contacts of patients with meningitis at highest risk?
first 7 days
| Risk persists for 4 weeks
98
Which antibiotic to give to treat UTI in a pregnant women at or near term?
Cefalexin or amoxicillin for 7 days
99
Risk of giving nitrofurantoin to a pregnant women at term
May induce haemolysis in the newborn
100
Vaccinations for patients with CKD including dialysis
Pneumococcus
Influenza
Hepatitis B
101
Classical features in Behcet's disease
Oral ulcers
Genital ulcers
Uveitis
102
When to send a urine culture in UTI for non-pregnant women?
age >65
| visible or non-visible haematuria
103
Age of first influenza vaccine
2-3 years
104
How many doses of tetanus are in the routine schedule?
5
105
What is a tetanus prone wound?
Puncture type injuries in contaminated environment e.g. gardening
Wounds with foreign bodies
Compound fractures
Wounds or burns with systemic sepsis
106
Tetanus prevention when patient has had full course of tetanus vaccines with last dose <10 years ago
No vaccine or immunoglobulin regardless of wound severity
107
Tetanus prevention when a patient has had a full course of tetanus vaccines with last dose >10 years ago
Tetanus prone wound = reinforcing dose of vaccine
High risk wounds = reinforcing dose of vaccine + tetanus immunogloublin
108
Tetanus prevention when vaccination history is unknown or incomplete
Reinforcing dose of vaccine regardless of wound severity
Tetanus prone and high risk wounds = reinforcing dose of vaccine + tetanus immunoglobulin
109
Which patient groups should have the pneumococcal vaccine every 5 years?
Splenectomy
| CKD
110
Malignancies associated with EBV
Burkitt's lymphoma
Hodgkin's lymphoma
Nasopharyngeal carcinoma
HIV associated CNS lymphoma
111
What aged children get the influenza vaccine?
2 to 10 years
112
Treatment of pubic lice
Malathion lotion or permethrin cream
Need to reapply after 7 days
113
Who gets the pneumococcal conjugate vaccine?
Children
114
Who gets the pneumococcal polysaccharide vaccine?
Adults
115
Which causes of gastroenteritis have incubation periods over 7 days?
Giardiasis
| Amoebiasis
116
Should asthmatics get the annual influenza vaccine?
Only if need steroid inhaler
117
Causes of painless genital ulcers
Syphilis
| Lymphogranuloma venereum
118
Causes of painful genital ulcers
Behcets
Herpes simplex
Chancroid
119
Antibiotic for cellulitis near the eyes
Co-amoxiclav
120
Antibiotic for cellulitis in pregnancy
Erythromycin
as you can't have clarithromycin during pregnancy
121
Features of catch scratch disease
Fever
History of cat scratch
Regional lymphadenopathy
Headache, malaise
122
Cutaneous larva migrans - features and treatment
Infection of dog hookworm
Itchy, creeping rash
Treatment: albendazole or ivermectin
123
Bed bugs management
Hot wash all clothes and bedding
Topical hydrocortisone for itching
Need pest management for house
124
What chemical to use for cleaning bodily fluids?
Hypochlorite
125
Giardiasis - presentation
```
Often asymptomatic
Lethargy, bloating, abdo pain
Flatulence
Non-bloody diarrhoea
Chronic diarrhoea, malabsorption, lactose intolerance
```
126
Giardiasis - treatment
metronidazole
127
Giardiasis - diagnosis
Stool microscopy often negative
Need duodenal fluid aspirates or 'string tests'
128
Malaria prophylaxis in pregnancy
Chloroquine
If taking proguanil need folate 5mg OD
129
Malarone side effects
GI upset
130
Malarone timing
1-2 days before travel
7 days after travel
131
Chloroquine side effects
Headache
132
Chloroquine contraindications
Epilepsy
133
Chloroquine - how often is it taken?
weekly
134
Chloroquine timing
1 week before travel
| 4 weeks after travel
135
Doxycycline side effects
Photosensitivity
| Oesophagitis
136
Doxycycline timings as malaria prophylaxis
1-2 days before travel
| 4 weeks after travel
137
Mefloquine side effects
dizziniess
| neuropsychiatric disturbance
138
Mefloquine timings
2-3 weeks before travel
| 4 weeks after travel
139
Proguanil timings
1 week before travel
| 4 weeks after travel
140
Proguanil + chloroquine timings
1 week before travel
| 4 weeks after travel
141
Deet usage in malaria areas
20-50% deet repels up to 100% mosquitoes
142
What aged can you start using DEET?
over 2 months
143
Treatment of malaria
If chloroquine sensitive area = artemisinin-based combination therapy (ACT) or chloroquine
If chloroquine resistant area = ACT
144
Treatment of malaria in pregnancy
Can't have ACT
Use chloroquine
145
What additional treatment should be given to patients with ovale or vivax malaria?
Primaquine
destroys liver hypnozoites to prevent relapse
146
Metronidazole - side effects
Disulfiram-like reaction with alcohol
147
What is non-gonococcal urethritis?
urethral discharge and dysuria, but swab doesn't show any gram negative diplococci
148
Causes of non-gonococcal urethritis
Chlamydia trachomatis
| Mycoplasma genitalium
149
Treatment of non-gonococcal urethritis
Contact tracting
| Oral azithromycin or doxycycline
150
Type of pneumonia classical in alcoholics
Klebsiella pneumoniae
151
What is strongyloidiasis caused by?
Parasitic worm
152
Features of strongyloidiasis
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
Most common cause of diarrhoea in HIV patients
Cryptosporidium
154
Examples of cephalosporins
Cefotaxime
Ceftriaxone
Cefalexin
155
Examples of quinolones
Ciprofloxacin
| Levofloxacin
156
Antibiotic to be used in gonorrhoea if won't have injection
oral cefixime + oral azithromycin
157
Most common cause of infective exacerbation of COPD
Haemophilus influenzae
158
Two most common causes of otitis externa
1) Pseudomonas aeruginosa
| 2) Staphylococcus aureus
159
Lymphogranuloma venereum - features
Painless ulcer on vagina, penis or anus
| Lymphadenopathy
160
Lymphogranuloma venerum - cause
Chlamydia trachomatis
161
Lymphogranuloma venerum - treatment
Doxycycline
162
Trichomonas vaginalis - features
Offensive yellow frothy discharge
Vulvovaginitis
Strawberry cervix
pH >4.5
163
Trichomonas vaginalis - investigations
Microscopy shows motile trophozoites
164
Trichomonas vaginalis - management
Oral metronidazole for 5-7 days
Or 2g metronidazole one off
165
What spreads African Trypanosomiasis?
Tsete fly
166
African trypanosomiasis - features
Chancre - painless nodule at infection site
Intermittent fever
Enlarged posterior cervical lymph nodes
CNS involvement leads to somnolence, headache, low mood, meningoencephalitis
167
American trypanosomiasis is also called what?
Chaga's disease
168
American trypanosomiasis - chronic features
Myocarditis causing dilated cardiomyopathy
Megaoesophagus causing dysphagia
Megacolon causing constipation
169
Initial management of active TB duration
2 months
170
Initial management of active TB drugs
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
171
What medication needs to be taken with isoniazid?
Pyridoxine (B6) to prevent peripheral neuropathy
172
Side effects of rifampicin
Liver enzyme inducer
Hepatitis
Orange secretions
Flu like symptoms
173
Side effects of isonidazide
Peripheral neuropathy (give pyridoxine)
Hepatitis
Agranulocytosis
Liver enzyme inhibitor
174
Side effects of pyrazinamide
Hyperuricaemia causing gout
Arthralgia
Mylagia
Hepatitis
175
Side effects of ethambutol
Optic neuritis so check visual acuity before and during treatment
176
Continuation phase of treating active TB duration
4 months
177
Drugs used in continuation phase of treating active TB
Rifampicin
| Isoniazid
178
Treatment for latent TB
3 months of isonidazid (+pyridoxine) and rifampicin
OR
6 months of isoniazid (+pyridoxine)
179
Treatment of meningeal TB
Treat for 12 months
| Add steroids
180
Symptoms of Zika virus
```
mild febrile illness for 2-7 days
arthralgia
rash
conjunctivitis
retroorbital pain
pruritis
```
181
Zika virus and pregnancy
Risk of microcephaly and congenital defects
Avoid pregnancy for 8 weeks after travelling to endemic area
182
Tests used to diagnose HIV
Combination test for HIV antibodies and p24 antigen
Repeat if positive
183
When to test for HIV in asymptomatic people who have come into contact?
4 weeks
If negative repeat at 12 weeks
184
When are HIV antibodies positive?
99% positive at 3 months
| Majority by 4 weeks
185
When are p24 antigen positive in testing for HIV?
Between week 1 and week 4
186
Features of HIV seroconversion
```
Sore throat
Lymphadenopathy
Diarrhoea
Maculopapular rash
Mouth ulcers
```
187
Toxoplasmosis - features
Constitutional symptoms
Headache
Confusion
Drowsy
188
Toxoplasmosis - findings on CT
Single or multiple ring enhancing lesions, may have mass effect
Thallium SPECT negative
189
Cryptococcus - findings on CT
meningeal enhancement
| cerebral oedema
190
Cryptococcus in HIV patients - features
Headache
Fever
N+V
Seizures
Focal neurology
High opening pressure on LP
CSF india ink positive
191
What is progressive multifocal leukoencephalopathy?
Widespread demyelination in HIV patients due to JC virus
192
Primary CNS lymphoma - CT findings
Single or multiple solid (homogenous) enhancing lesions
Thallium SPECT positive
193
Cause of syphilis
Trepnonema pallidum
194
Primary syphilis
Chancre - painless ulcer
Local non-tender lymphadenopathy
In women lesion may be on cervix
195
Secondary syphilis
6-10 weeks later
Fevers, lymphadenopathy
Rash
Buccal "snail track" ulcers
Condylomata lata (painless warty lesions on genitals)
196
Tertiary syphilis
Gummas (granulomatous lesions on skin and bones)
Ascending aortic aneuryms
General paralysis of the insane
Argyll-Robertson pupil
197
Congenital syphilis
```
Hutchinsons teeth "mulberry molars"
Rhagades (linear scars at angle of mouth)
Keratitis
Saddle nose
Deafness
```
198
Rubella - features
Low grade fever
Maculopapular rash, starts on face then spreads to body
Lymphadenopathy
199
Mumps - features
Fever
Malaise, muscle aches
Parotitis
200
Mumps - complications
Orchitis in 35% post pubertal males
Hearing loss - unilateral, transient
Meningoencephalitis
Pancreatitis
201
Mumps - vaccine efficacy
MMR vaccine 80% effective
202
Mumps - management
Supportive
| Notifiable disease
203
Legionella - features
```
Flu like symptoms, fever
Dry cough
Relative bradycardia
Confusion
Lymphopenia
Hyponatraemia
Deranged LFTs
Pleural effusion
```
204
Legionella - diagnosis
Urinary antigen
205
Legionella - management
Erythromycin or clarithromycin
206
Hepatitis A - spread
Faecal oral
207
Hepatitis A - features
```
Flu like prodrome
RUQ pain
tender hepatomegaly
Jaundice
Cholestatic LFTs
```
208
Who should be vaccinated against Hep 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
Hepatitis B - spread
Exposure to infected blood or body fluids
| Vertical transmission
210
Hepatitis B - features
Fever
Jaundice
Elevated liver transaminases
211
Hepatitis B - complications
```
Chronic hepatitis
Fuliment liver failure
HCC
Glomerulonephritis
Polyarteritis nodosa
Cryoglobulinaemia
```
212
Hepatitis B - management
Pegylated interferon alpha
213
What is considered a good response to hep B vaccine?
Anti-HBs >100
214
What is considered a suboptimal response to hep B vaccine and what are the next steps?
Anti-HBs 10-100
1x further vaccine dose
215
What is considered a non-responder to hep B vaccine and what are the next steps?
<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
Hepatitis C - features
70% asymptomatic
Jaundice
Fatigue
Transient rise in aminotransferase
217
Hepatitis C - investigations
HCV RNA for acute infection
Anti-HCV antibodies (these will remain in patients who spontaneously clear the virus)
218
Hepatitis C - what % will clear the acute infection?
15-45%
219
What is defined as chronic hepatitis C?
Persistence of HCV RNA in the blood for 6 months
220
Complications of chronic hepatitis C
```
sjogren's syndrome
arthritis
cirrhosis
HCC
cryoglobulinaemia
porphyria cutanea tarda
glomerulonephritis
```
221
Chronic hepatitis C - management
Protease inhibitors +/0 ribaviran
222
Chronic hepatitis C - with treatment what % clear the virus?
95%
223
Ribavirin side effects
Haemolytic anaemia
Cough
Teratogenic - can't get pregnant for 6 months after
224
What is ribavirin used for?
Chronic hepatitis C
225
Which virus does hepatitis D need to exist?
Hep B
226
Hepatitis D - co-infection definition
Hepatitis B and hepatitis D infection at the same time
227
Hepatitis D - superinfection definition
Hepatitis B surface antigen positive patient subsequently develops hep D
228
What are the risks of hepatitis D superinfection?
Fulminant hepatitis
Chronic hepatitis status
Cirrhosis
229
How is leptospirosis spread?
Infected rat urine
at risk are sewage workers, farmers, vets, abattoir workers
230
Leptospirosis - symptoms
Fever, flu like symptoms
Subconjunctival haemorrhage
Later stages:
AKI
Hepatitis with jaundice and hepatomegaly
Aseptic meningitis
231
Leptospirosis - investigations
Serology - antibodies
232
Leptospirosis - management
high dose benzylpenicillin or doxycycline
233
Brucellosis - features
Fever
Hepatosplenomegaly
Sacroiliitis
Leukopenia
234
Brucellosis - diagnosis
rose bengal test for screening
| brucella serology
235
Brucellosis - management
doxycycline and streptomycin
236
Dengue fever - complications
Viral haemorrhagic fever causing dengue shock syndrome
237
Dengue fever - presentation
Headache
Fever
Myalgia
Pleuritic pain
Facial flushes
Maculopapular rash
238
Infectious mononucleosis - features
```
Sore throat
Lymphadenopathy
Pyrexia
Splenomegaly
Palatal petechiae
```
239
Infectious mononucleosis - diagnosis
Monospot test aka heterophil antibody test
240
Infectious mononucleosis and sport
Avoid contact sports for 8 weeks due to risk of splenic rupture
241
Lyme disease - cause
Borrelia burgdorferi
spread by tics
242
Lyme disease - early features
```
Erythema chronicum migrans - bulls eye rash at bite site 1-4 weeks later
Headache
Lethargy
Fever
Arthralgia
```
243
Lyme disease - late features
Cardio = heart block, peri/myocarditis
Neuro = facial nerve palsy, radicular pain, meningitis
244
Lyme disease - investigations
Clinical diagnosis if erythema migrans present
ELIZA
Immunoblot test
245
Lyme disease - management in early disease
Management in pregnancy
Doxycycline
if C/I (eg pregnant) then amoxicillin
246
Lyme disease - management in disseminated disease
Ceftriaxone
247
Gonorrhoea - cause
Neisseria gonorrhoeae
248
Gonorrhoea - features
Men: Urethral discharge, dysuria
Women: Cervicitis
249
Gonorrhoea - management
IM ceftriaxone 1g stat + oral azithromycin 1g
IF SENSITIVITIES KNOWN then stat dose oral cipro 500mg
250
Chlamydia - cause
Chlamydia trachomatis
251
Chlamydia - features
Women: Cervicitis, dysuria
Men: urethral discharge, dysuria
252
What % of women with chlamydia are asymptomatic?
70%
253
What % of men with chlamydia are asymptomatic?
50%
254
Chlamydia - investigations
NAAT (nuclear acid amplification test)
Urine, vulvovaginal or cervical swab
2 weeks after exposure
255
Chlamydia - management
Management if pregnant
Doxycycline for 7 days
If C/I (eg pregnant) then azithromycin 1g OD for 1 day or 500mg OD for 2 days
256
Chlamydia - partner notification for symptomatic men
All contacts since symptoms started and 4 weeks before
257
Chlamydia - partner notification for women and asymptomatic men
All contacts for the last 6 months and most recent sexual partner
258
Chlamydia - antibiotic in pregnancy
Azithromycin
259
Campylobacter - features
Prodrome of headache, malaise
Bloody diarrhoea
Abdo pain
May mimic appendicitis
260
Campylobacter - management
Treat if severe or immunocompromised
1st line: clarithromycin
2nd line: ciprofloxacin
261
Campylobacter - complications
Guillian-Barre
Reactive arthritis
Septicaemia
Endocarditis
262
Herpes simplex virus - management of gingivostomatitis
Oral aciclovir
| Chlorhexidine mouthwash
263
Herpes simplex virus - management in pregnancy
Elective section if primary attack >28 weeks
If recurrent herpes then suppressive therapy
264
What is bacterial vaginosis?
Overgrowth of anaerobic organisms causing fall in anaerobic lactobacilli which raises pH
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Bacterial vaginosis - features
Asymptomatic in 50%
Discharge is fishy, thin, white
vaginal pH >4.5
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Bacterial vaginosis - microscopy
Clue cells
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Bacterial vaginosis - risks to pregnancy
Preterm labour
Low birth weight
Chorioamnionitis
Late miscarriage
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Bacterial vaginosis - management in pregnancy
Oral metronidazole
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Bacterial vaginosis - management
Oral metronidazole
70% initial cure but >50% relapse
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What is Leishmaniasis spread by?
sand fly bites
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Cutaneous Leishmaniasis
Crusted lesion at site of bite
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Mucocutaneous leischmaniasis
Skin lesions spread to involve mucosae of nose, pharynx, etc
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Visceral leischmaniasis - features
Fever, sweats
Massive splenomegaly, hepatomegaly
Grey skin
Pancytopenic secondary to hypersplenism
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What is enteric fever also called?
Typhoid and paratyphoid
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Enteric fever - features
Fever, headache
Relative bradycardia
Abdo pain and abdo distension
Constipation
Rose spots on trunk
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Enteric fever - complications
Osteomyelitis
GI bleed or perf
Meningitis
Cholecystitis
Chronic carriage
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Mycoplasma pneumoniae - features
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Gradual onset, flu like symptoms
COld agglutins cause haemolytic anaemia
Erythema multiform or erythema nodosom
Meningoencephalitis
Pericarditis
Hepatitis
Glomerulonephritis
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Mycoplasma pneumoniae - diagnosis
Mycoplasma serology
| Positive cold agglutination test
