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MRCP > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

Pneumonia + Alcoholic + Cavitation =
Pneumonia + Prior Flu =
Pneumonia + Chicken Pox Rash =
Pneumoniae Pneumonia + Hemolytic Anemia =
Pneumonia + Hyponatraemia + Travel History =
Pneumonia + Fleeting opacities =
Pneumonia + Fits/LOC =
Pneumonia + HSV oral lesion =
Pneumonia + parrot =
Pneumonia + farm animals =
Pneumonia + HIV =
Pneumonia + Cystic fibrosis =
Pneumonia + COPD or exac =

A

Pneumonia + Alcoholic + Cavitation = Klebsiella
Pneumonia + Prior Flu = Staph Pneumonia
Pneumonia + Chicken Pox Rash = Varicella
Pneumoniae Pneumonia + Hemolytic Anemia = Mycoplasma
Pneumonia + Hyponatraemia + Travel History = Legionella
Pneumonia + Fleeting opacities = Cryptogenic Pneumonia
Pneumonia + Fits/LOC = Aspiration Pneumonia
Pneumonia + HSV oral lesion = Strep Pneumonia
Pneumonia + parrot = Chlamydia psitatssi
Pneumonia + farm animals = Q fever (coxillea brunetii)
Pneumonia + HIV = think pcp but if straight forward case strep pneumonia is still most common
Pneumonia + Cystic fibrosis = consider pseudomonas/Burkholderia
Pneumonia + COPD or exac = c1::Haemophilus Influenza

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2
Q

Commonest cause of CAP =

A

Strep Pneumonia

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3
Q

What infections can cause caveatting lesions in the lungs? (4)

A

Staph aureus
Klebsiella
TB
Aspergillosa

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4
Q

What should you do if you have a needlestick from suspected/confirmed Hep B patient?

A

If responder to vaccine -> need a booster
If non-responder -> need Hep B immunoglobulins + vaccine
If only had one jab so far -> need Hep B immunoglobulins + vaccine

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5
Q

What should you do if you have a needlestick from suspected/confirmed Hep C patient?

A

monthly PCR - if seroconversion then protease inhibitors +/- ribavirin PO

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6
Q

What should you do if you have a needlestick from suspected/confirmed Hep A patient?

A

Human Normal Immunoglobulin (HNIG) or hepatitis A vaccine may be used

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7
Q

What should you do if you have a needlestick from suspected/confirmed HIV patient?

A

a combination of PO antiretrovirals (e.g. Tenofovir, emtricitabine, lopinavir and ritonavir) asap (i.e. within 1-2 hrs, but may be started up to 72 hrs) for 4 weeks
serological testing at 12 wks following completion of PEP
reduces risk of transmission by 80%

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8
Q

What should you do with pregnant women/IC if exposed to varicella zoster?

A

If pregnant – check Abs

  • If <20wks + not immune, give VZIg
  • If >20wks + not immune, give VZIg or aciclovir from day 7-14
  • If develops chickenpox, give PO aciclovir if >20wks and 24hrs since onset of rash
  • Consider the above if <20wks pregnant
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9
Q

How to treat human and animal bites?

A

Co-amox
if penicillin-allergic then doxycycline + metronidazole

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10
Q

What is the most common organism that may infected a patient following an animal bite?

A

Pasteurella multocida

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11
Q

What is the most common organism that may infected a patient following a human bite?

A

Human bites commonly cause multimicrobial infection

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12
Q

Which bacteria cause fish tank granulomas?

A

Mycobacterium marinum

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13
Q

Which HIV patients should receive prophylaxis for PCP?

A

all patients with a CD4 count < 200/mm³

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14
Q

What is a common complication of PCP?

A

Pneumonthorax

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15
Q

Name the gram positive rods?

A

ABCD-L
Actinomyces
Bacillus anthraces
Clostridioides spp
Diphtheria
Listeria

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16
Q

What are the five types of malaria?

A

Plasmodium vivax – most © non-falciparum
Plasmodium ovale – more © Africa
Plasmodium malariae – associated with nephrotic syndrome
Plasmodium falciparum ©-est! – often causes severe malaria
Plasmodium knowlesi

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17
Q

Protective conditions/genetics for malaria?

A
  • SCA
  • G6PD deficiency
  • HLA-B53
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18
Q

Malaria host?

A

Female Anopheles mosquito

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19
Q

Features of severe malaria?

A

schizonts on a blood film
parasitaemia > 2%
hypoglycaemia
acidosis
temperature > 39 °C
severe anaemia
complications: cerebral malaria, renal failure, ARDS, DIC

STARCHS

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20
Q

What type of fever might you see with the non-falciparum malarias?

A

Plasmodium vivax/ovale: cyclical fever every 48 hours
Plasmodium malariae: cyclical fever every 72 hours
Knowlesi: every 24 hours

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21
Q

Which malaria prophylaxis to give pregnant women?

A

Chloroquine

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22
Q

Which malaria prophylaxis to give children?

A

DEET
Doxy if >12yo

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23
Q

Treatment of severe malaria?

A 
IV artesunate (alternative = quinine) 
- If parasite count \>10%, consider exchange transfusion
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24
Q

Treatment of uncomplicated falciparum malaria?

A

artemisinin combination therapies (ACT) e.g. artemether-lumefantrine

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25
Q

Treatment of non-falciparum malaria?

A

chloroquine (P. vivax + ovale) + primaquine (to eradicate liver hypnozoites)

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26
Q

Investigations in malaria?

A

Thick blood smear – locates parasites in RBCs
Thin blood smear – directly identifies the plasmodium species
Bloods may show:
- Thrombocytopaenia
- Elevated LDH
- Normochromic, normocytic anaemia
- Normal WCC

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27
Q

Mechanism by which malaria affects the body?

A

Mosquito gets infected by gametocytes
Plasmodium resides in salivary glands -> injected into humans when bitten

Exoerythrocytic Phase - asymptomatic
Over 1-2 weeks undergoes asexual reproduction in the liver
May then go dormant for months/years (P. vivax/ovale)

Erythrocytic Phase
Released into blood -> invade RBCs
P. vivax only invades reticulocytes
P. malariae only invade old RBCs
Undergo more reproduction
RBC bursts and releases contents
This happens in waves in tune with reproductive cycles -> causes a ‘swinging fever’
Haemolytic anaemia happens as a results and is responsible for fatigue, headaches, jaundice, splenomegaly

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28
Q

What might you see in the CSF in Listeria?

A

CSF may reveal a pleocytosis, with ‘tumbling motility’ on wet mounts

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29
Q

How to treat listeria infection incl in the case of meningitis?

A

Listeria is sensitive to amoxicillin/ampicillin (cephalosporins usually inadequate)
Listeria meningitis should be treated with IV amoxicillin/ampicillin and gentamicin

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30
Q

What type of virus is hep C?

A

RNA flavivirus

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31
Q

What test to confirm exposure and then ongoing infection in Hep C?

A

HCV Abs confirms exposure
HCV-RNA PCR confirms ongoing infection/chronic

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32
Q

If HCV-PCR positive, what further investigation should you do?

A

Transient elastography to assess for liver damage

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33
Q

How to treat Hep C?

A

Avoid alcohol
Combination therapy: protease inhibitors +/- ribavirin PO
- Virus is cleared in 95% of patients
- Ribavirin = teratogenic, women should not become preg within 6m

Liver transplantation may be considered
Aim for undetectable viral load

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34
Q

Complications of Hep C?

A
  • Arthralgia/arthritis
  • Sjogren’s syndrome
  • Cirrhosis/HCC
  • Cryoglobulinaemia (type 2)
  • Porphyria cutanea tarda
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35
Q

Features of campylobacter GI infection?

A

A flu-like prodrome usually followed by crampy abdo pains, fever + diarrhoea (may be bloody)
May mimic appendicitis

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36
Q

Management and complication of campylobacter?

A

Complications include GBS
Mx: clarithromycin

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37
Q

What to offer a chlamydia contact?

A

Offer Chlamydia testing and antibiotic treatment immediately without waiting for the results

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38
Q

What is the causative organism for Q fever?

A

Coxiella burnetii

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39
Q

How do you treat Q fever?

A

doxycycline

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40
Q

What type of people get Q fever?

A

Farmers
Typically caught from cattle/sheep or inhaled from infected dust

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41
Q

What type of virus is measles?

A

RNA paramyxovirus

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42
Q

What is the measles incubation period?

A

10-14 days

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43
Q

When is measles infective?

A

from prodrome -> 4/7 of rash

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44
Q

What are the features of measles?

A

Prodrome: fever, irritable, conjunctivitis
Koplik spots on buccal mucosa – before rash
Rash – starts behind ears, maculopapular -> blotchy
Diarrhoea in 10% of patients

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45
Q

Complications of measles?

A

Otitis media ©
Pneumonia – most © cause of death
Encephalitis – typically 1-2wks after illness onset
Subacute sclerosing panencephalitis – may occur 5-10yrs later
- Fatal within 1-3yrs
Febrile convulsions
Keratoconjunctivitis
Myocarditis/appendicitis

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46
Q

Most common causative organism of travellers diarrhoea?

A

E. coli

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47
Q

Cause of prolonged, non-bloody diarrhoea?

A

Giardiasis

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48
Q

Cause of profuse, watery diarrhoea + severe dehydration resulting in WL?

A

Cholera

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49
Q

Cause of bloody diarrhoea, vomiting and abdo pain?

A

Shigella

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50
Q

Symptoms of bacillus cereus infection?

A

Two types of illness are seen
• Vomiting within 6 hours (often d/t rice)
• Diarrhoeal illness occurring after 6hrs

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51
Q

Incubation periods for common gastro bugs?

A
  • 1-6 hrs: Staphylococcus aureus, Bacillus cereus
  • 12-48 hrs: Salmonella, E. coli
  • 48-72 hrs: Shigella, Campylobacter
  • >7 days: Giardiasis, Amoebiasis
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52
Q

How is giardiasis spread?

A

Faeco-oral route

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53
Q

Symptoms of giardiasis?

A

Often asymptomatic
Lethargy, bloating, abdo pain
Flatulence
Non-bloody greasy chronic diarrhoea -> due to malabsorption

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54
Q

Investigation in giardiasis?

A

duodenal fluid aspirates or ‘string tests’ (fluid absorbed onto swallowed string) are sometimes needed

Stool tests are often negative

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55
Q

Treatment of giardiasis?

A

Metronidazole

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56
Q

Which vaccines are CI in HIV positive patients?

A

Cholera intranasal
Poliomyelitis-oral
Tuberculosis (BCG)

TCP

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57
Q

Which vaccines are not given if CD4 <200?

A

MMR
Varicella
Yellow fever

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58
Q

What type of virus is Orf?

A

Parapox virus

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59
Q

What are the features of Orf?

A

Affects hands/arms
Small raised red-blue papules -> 2-3cm flat-topped + haemorrhagic

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60
Q

Features of hand, foot and mouth disease?

A

Sore throat/fever
Oral ulcers
Followed by vesicles on the palms and soles of the feet

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61
Q

How to treat cerebral toxoplasmosis in IC pts?

A

pyrimethamine + sulphadiazine for 6wks
Nothing in patients without immunocompromise

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62
Q

What are the two different types of trypanosomiasis?

A 
African trypanosomiasis (sleeping sickness) 
American trypanosomiasis (Chagas' disease)
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63
Q

What are the two different types of african trypanosomiasis?

A 
Trypanosoma gambiense (West Africa) 
Trypanosoma rhodesiense (East Africa) 
- the Gambia is in West Africa
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64
Q

How is trypanosomiasis spread?

A

Tsetse fly

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65
Q

Features of African trypanosomiasis?

A

Trypanosoma chancre – at site of infection
Intermittent fever
Posterior cervical lymphadenopathy
Later: CNS involvement – headache, mood changes, meningoencephalitis

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66
Q

Management of African trypanosomiasis?

A

early disease: IV pentamidine or suramin
later disease or CNS involvement: IV melarsoprol

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67
Q

Features of Chagas disease?

A

95% are asymptomatic
chagoma (an erythematous nodule at site of infection) and periorbital oedema are sometimes seen

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68
Q

Chronic infection with Chagas Disease complications?

A

Myocarditis -> dilated cardiomyopathy and arrythmias
GI features -> megaoesophagus/megacolon causing dysphagia + constipation

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69
Q

Management of Chagas Disease?

A

Acute phase - benznidazole or nifurtimox
Chronic phase – treating the complications

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70
Q

Investigations of PCP?

A 
CXR – bilateral pulmonary infiltrates 
Bronchoalveolar lavage (BAL) often needed to demonstrate PCP – use silver stain
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71
Q

Management of PCP?

A

Co-trimoxazole
IV pentamidine for severe cases
Steroids if hypoxic

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72
Q

Common complication of PCP?

A

Pneumothorax

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73
Q

What bug causes Lyme disease?

A

Caused by Borrelia burgdorferi

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74
Q

Presentation of Lyme disease?

A

Early – erythema chronicum migrans (target) rash (seen in 80%), headache, fever, arthralgia
CVS – heart block, myocarditis
Neuro – facial nerve palsy, meningitis

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75
Q

Investigations for Lyme disease?

A

Clinical Dx
ELISA for Abs (IgG + IgM)
- If negative, can repeated 4-6wks after the first
If +ve (or -ve but high suspicion), then immunoblot test (western blot) should be done

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76
Q

Management of Lyme disease?

A

Doxycycline if early disease
If CI, give Amoxicillin (e.g. pregnancy)
Ceftriaxone if disseminated disease

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77
Q

What is the Jarisch-Herxheimer reaction?

A

sometimes seen after initiating therapy in Lyme disease/syphilis

  • Reaction produced from the death of microorganisms on starting abx (endotoxin-like)
  • Fever, rash, tachycardia
  • No treatment needed
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78
Q

In addition to 12-13yo girls (and now boys), who else should be given the HPV vaccine?

A

HPV vaccination should also be offered to men who have sex with men under the age of 45 to protect against anal, throat and penile cancers

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79
Q

Which HPV strains are you protected against with the vaccine?

A

6, 11, 16 and 18

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80
Q

Which bacteria are gram negative cocci?

A

Neisseria meningitidis + Neisseria gonorrhoeae, also Moraxella catarrhalis

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81
Q

Which bacteria are gram positive cocci?

A

staphylococci + streptococci (including enterococci)

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82
Q

What percentage of hep C will turn chronic?

A

55-85%

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83
Q

Other than usual pneumonia symptoms, what symptoms might you get in legionella pneumonia?

A

relative bradycardia
confusion
hyponatraemia
deranged LFTs
pleural effusion: seen in around 30% of patients

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84
Q

How to investigate legionella?

A

Urinary antigen

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85
Q

Management of legionella?

A

erythromycin/clarithromycin

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86
Q

What class of bacteria is H. influenzae in?

A

gram negative coccobacilus

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87
Q

Staph, coagulase negative vs positive example?

A

Coag -ve: S. epidermidis
Coag +ve: S. aureus

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88
Q

What to do if <20 weeks pregnant and exposed to varicella with no previous infection?

A

Give immunoglobulins

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89
Q

What is Lemierre’s syndrome?

A

an infectious thrombophlebitis of the internal jugular vein

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90
Q

What causes Lemierre’s syndrome?

A

occurs secondary to a bacterial sore throat caused by Fusobacterium necrophorum leading to a peritonsillar abscess. A combination of spread of the infection laterally from the abscess and compression lead to thrombosis of the IJV.

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91
Q

Presentation of Lemierre’s syndrome?

A

history of bacterial sore throat followed by neck pain, stiffness and tenderness (may be mistaken for meningitis) and systemic involvement (fevers, rigors, etc)

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92
Q

Complication of Lemierre’s syndrome?

A

Septic pulmonary emboli

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93
Q

What type of bug causes schistosomiasis?

A

Parasitic flatworm

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94
Q

What are the acute symptoms of schistosomiasis?

A

• Swimmers itch
• Acute schistosomiasis syndrome (Katayama fever)
o Fever
o Urticaria
o Arthralgia
o Cough
o Diarrhoea
o Eosinophilia

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95
Q

What does schistosoma haematobium do and what complications can it lead to?

A

Deposit eggs clusters in the bladder -> inflammation + calcification
- causes frequency/haematuria
o Can cause obstructive uropathy/kidney damage
o Risk of bladder SCC

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96
Q

What does Schistosoma mansoni + Schistosoma japonicum do?

A

Mature in liver - travel through portal system to distal colon
o Can cause progressive hepatomegaly + splenomegaly due to portal vein congestion
o Can also cause liver cirrhosis, variceal disease + cor pulmonale

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97
Q

How do you manage schistosomiasis?

A

Praziquantel

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98
Q

What to do if IC individual e.g. on Mtx, is exposed to varicella?

A

Check Abs
Give VZIg if -ve
Don’t delay giving VZIg past 7/7 whilst waiting for Abs

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99
Q

What type of virus is Rabies?

A

RNA rhabdovirus

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100
Q

What are the symptom of Rabies?

A

Headache, fever, agitation
Hydrophobia
Hypersalivation

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101
Q

What is seen on microscopy in Rabies?

A

Negri bodies: cytoplasmic inclusion bodies found in infected neurons

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102
Q

How to treat Rabies?

A

Wash wound
Two further doses of vaccine required
If not previous immunised, human rabies immunoglobulin should be given alongside full course of vaccination

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103
Q

How do strongyloides travel through the body?

A

Worm enters through the skin -> travels to the lungs -> trachea -> pharynx -> is swallowed to the small intestine and lays eggs in the mucus

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104
Q

What are the features of strongyloidiasis and what is the name of the skin condition?

A

Diarrhoea
Abdo pain/bloating
Papulovesicular lesions where larvae have penetrated e.g. soles/buttocks
Larvae currens – the path of the worm below the skin, disappears

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105
Q

How to treat strongyloidiasis?

A

Ivermectin
Albendazole

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106
Q

Which organism are usually responsible for PID?

A

Chlamydia trachomatis
Neisseria gonnorrhoeae
Mycoplasma genitalium
Mycoplasma hominis

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107
Q

Features of PID?

A

Abdo pain
Fever
Deep dyspareunia
Dysuria + menstrual irregularities
Vaginal or cervical discharge
Cervical excitation

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108
Q

Investigations in PID?

A

Preg test to exclude an ectopic
High vaginal swab
Screen for Chlamydia/Gonorrhoea

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109
Q

Management of PID?

A

Low threshold for treatment
PO oflaxacin + PO metronidazole
Or IM ceftriaxone + PO doxycycline + PO metronidazole
Consider removal of IUD

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110
Q

Complications in PID?

A

Perihepatitis (Fitz-Hugh Curtis Syndrome)
- Occurs in 10% of cases
- RUQ pain
Infertility
Chronic pelvic pain
Ectopic pregnancy

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111
Q

Incubation period for chickenpox?

A

10-21 days

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112
Q

Infective period for chickenpox?

A

4/7 before rash -> 5/7 after rash

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113
Q

Management of chickenpox?

A

Calamine lotion
School exclusion – until lesions have crusted
IC patients/newborns should receive VZIg if Ab negative
Consider IV aciclovir

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114
Q

Complications of chickenpox?

A

Secondary bacterial infection
- NSAIDs may increase risk
- Risk: group A strep soft tissue infection -> nec fasc
Pneumonia – most © complication, ausculatation often unremarkable
Encephalitis

A little similar to measles

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115
Q

What bacteria causes chlamydia?

A

Chlamydia trachomatis

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116
Q

What are the symptoms of chlamydia if any?

A

Urethritis and vaginal discharge

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117
Q

Ix for chlamydia?

A

NAAT testing
Women - high vaginal swab
Men - urine

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118
Q

Management of chlamydia? What if pregnant?

A

Doxycycline - 1st line
Azithromycin
Preg - azithro/erythro/amoxicillin

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119
Q

Complications of chlamydia?

A

Reactive arthritis
PID

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120
Q

What bacteria causes thrush?

A

Candida albicans

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121
Q

What are the RFs for thrush?

A

Pregnancy
Diabetes
Antibiotics

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122
Q

What are the symptoms of thrush?

A

Cottage cheese discharge
Vulval irritation + itching
May also have sup dyspyrunia + dysuria + inflamed/red vagina or vulva

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123
Q

Ix for thrush?

A

High vaginal swab

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124
Q

Management of thrush?

A

Clotrimazole/PO fluconazole

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125
Q

What is the main organism to cause BV?

A

Gardnerella vaginalis

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126
Q

What are the symptoms of BV?

A

Grey-white discharge
Fishy odour
NOT itchy/red

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127
Q

What is Amsel’s criteria for BV?

A

pH >4.5
Positive whiff test
Presence of ‘clue cells’ on microscopy
Thin white discharge
(need 3/4)

128
Q

What is the management of BV?

A

Metronidazole PO
Clindamycin cream

129
Q

Complications of BV?

A

PID
Preterm labour

130
Q

What are the symptoms of trichomoniasis? Usual presentation in men?

A

Offensive grey-green discharge (frothy)
Cervicitis = punctuate ‘strawberry’ appearance
Vulval irritation and sup dyspareunia
Men - urethritis

131
Q

How to diagnose trichomoniasis?

A

microscopy of a wet mount shows motile trophozoites

132
Q

pH in trichomoniasis?

A

>4.5

133
Q

Treatment of trichomoniasis?

A

Metronidazole 5-7/7
Can do one off 2g

134
Q

Normal vaginal pH, bacteria and cells?

A

Squamous cell
Colonised with lactobacillus
pH <4.5

135
Q

Organism causing gonorrhoea?

A

Neisseria gonorrhoea

136
Q

Symptoms of gonorrhoea?

A

Asymptomatic
May have vaginal discharge, urethritis, cervicitis

137
Q

Diagnosis of gonorrhoea?

A 
Endocervical swabs (women) 
Urethral swab (men)
138
Q

Management of gonorrhoea?

A

Ciprofloxacin (although increasing antibiotic resistance)
1st line: IM ceftriaxone (can add azithro if needed)

139
Q

Complications of gonorrhoea?

A

Bacteraemia
Septic arthritis
PID (second most (c) cause after chlamydia)
Infertility

140
Q

What else do you need to consider when you diagnose gonorrhoea?

A

Partner notification and contact tracing

141
Q

Organism causing genital warts?

A

Condylomata acuminata

142
Q

Cause of genital warts?

A

HPV 6 + 11

143
Q

Treatment of genital warts?

A

Topical podophyllin/cryotherapy
Imiquimod cream

144
Q

Recurrence risk in genital warts?

A

25%

145
Q

Herpes symptoms?

A

Primary infection = the worst
Multiple small PAINFUL vesicles around introitus
Local lymphadenopathy
Dysuria
Systemic symptoms

146
Q

What percentage of patients get a reactivation of their herpes?

A

75%
The virus lies dormant in the dorsal root ganglion

147
Q

Investigation for herpes?

A

Viral swabs

148
Q

Treatment of herpes?

A

Aciclovir
Analgesia, rest, bathe in warm water

149
Q

Causes of painless/painful ulcers?

A

Painless:
Syphilis
Lymphogranuloma venereum

Painful:
Herpes
Chancroids
Behcets

150
Q

Incubation period in syphilis?

A

9-90 days

151
Q

Syphilis - primary features?

A

Chancre – painLESS ulcer at site of sexual contact
- In women, may be on the cervix
Local non-tender lymphadenopathy

152
Q

Syphilis - secondary features?

A

(6-10wks later)
Systemic – fever, lymphadenopathy
Rash on trunk, palm and soles
Buccal ‘snail track’ ulcers - white
Condylomata lata (painless warty lesions on genitals)

153
Q

Syphilis - tertiary features?

A

gummas (granulomatous lesions of the skin and bones)
ascending aortic aneurysms
general paralysis of the insane
tabes dorsalis – sensory demyelination causing locomotor ataxia
Argyll-Robertson pupil

154
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 (anterior bowing of the shin)
saddle nose
deafness

Saber shins, saddle nose, SN deafness

Short teeth, scars at edge of mouth

155
Q

Investigations in syphilis?

A

Cardiolipin tests

  • VDRL + RPR
  • Become negative after treatment

Treponemal specific antibody tests

  • TPHA
  • Remains positive after treatment
156
Q

Causes of false positive cardolipin tests?

A

pregnancy
SLE, anti-phospholipid syndrome
TB
leprosy
malaria
HIV

157
Q

Causes of false positive cardolipin tests?

A

pregnancy
SLE, anti-phospholipid syndrome
TB
leprosy
malaria
HIV
‘SomeTimes Mistakes Happen’ (SLE, TB, malaria, HIV)

158
Q

Which organism causes chancroid?

A

Haemophilus ducreyi

159
Q

Symptoms of chancroid?

A

causes painful genital ulcers associated with unilateral, painful inguinal lymph node enlargement. The ulcers typically have a sharply defined, ragged, undermined border

160
Q

What is the groove sign?

A

raised LNs either side of the inguinal ligament (which isn’t inflamed)

161
Q

What is the groove sign?

A

Sign seen in lymphogranuloma venereum - raised LNs either side of the inguinal ligament (which isn’t inflamed)

162
Q

What are the three stages of lymphogranuloma venereum?

A

stage 1: small painless pustule which later forms an ulcer
stage 2: painful inguinal lymphadenopathy
stage 3: proctocolitis

163
Q

How to treat lymphogranuloma venereum?

A

Doxy

164
Q

How to treat lymphogranuloma venereum?

A

Doxy

165
Q

Where can you catch brucellosis?

A

© Middle East + farmers/vets/abattoir (slaughterhouse) workers
4 main species causing human infection come from sheep, cattle and pigs
Can be caught from unpasteurised products

166
Q

Features of brucellosis?

A

Fever
Hepatosplenomegaly
Sacroiliitis/spinal tenderness
Complications – osteomyelitis, infective endocarditis, meningoencephalitis, orchitis
Leukopaenia

167
Q

Investigations in Brucellosis?

A

Rose Bengal plate test – used for screening
Brucella serology – best for diagnosis
Blood/BM cultures may be useful but are often negative

168
Q

Management of brucellosis?

A

Doxycycline + streptomycin

169
Q

What condition can cause a false negative tuberculin test?

A

military TB, sarcoidosis, HIV, lymphoma, very young age <6m

170
Q

When can you give sequential live vaccines?

A

Either on the same day or 4 weeks apart

171
Q

Other than staph + step, what may be isolated following a human bite?

A

Eikonella corrodens
Also Fusobacterium and Prevotella

172
Q

Antibiotic for invasive diarrhoea/immunocompromised/bloody diarrhoea?

A

Ciprofloxacin

173
Q

What causes nec fasc?

A

Type 1 © – caused by mixed anaerobes + aerobes (often post-surgery in DM)
Type 2 – caused by Streptococcus pyogenes (gram +ve cocci in chains)

174
Q

What commonly causes cellulitis?

A

strep pyogenes / staph aureus

175
Q

What is Eron classification?

A

Class 1: No signs of systemic toxicity + no uncontrolled co-morbidities
Class 2: Either systemic unwell/well but with a co-morbidity (e.g. PAD, morbid obesity) which may complicate or delay resolution of infection
Class 3: Significant systemic upset e.g. acute confusion, tachycardia, tachypnoea, hypotension or unstable co-morbidities that may interfere with the response to Tx, or a limb-threatening infection d/t vascular compromise
Class 4: Sepsis syndrome or a severe life-threatening infection e.g. necrotising fasciitis

176
Q

Features of rheumatic fever?

A

Fever
Erythema marginatum
Sydenham’s chorea: often late feature
Polyarthritis
Carditis/vulvitis

177
Q

Investigations for rheumatic fever?

A

Raised inflam markers
ECG: prolonged PR (T1 HB)

178
Q

Management of rheumatic fever?

A

Penicillin V
NSAIDs
Treat complications

179
Q

What causes EBV?

A

HHV-4 in 90% of cases

180
Q

What is the classic triad in EBV?

A

Sore throat
Lymphadenopathy - ant/post
Pyrexia

Also splenomegaly (50%), malaise, headache

181
Q

How long do symptoms usually last in EBV?

A

2-4 weeks

182
Q

How to diagnose EBV?

A

Monospot + FBC in 2nd week of illness

FBC - >20% reactive lymphocytes

183
Q

What conditions are associated with EBV?

A

Burkitt’s lymphoma
Hodgkin’s lymphoma
Nasopharyngeal carcinoma

184
Q

How do you treat EBV?

A

Rest, fluids, avoid alcohol
Simple analgesia
Avoid playing sport for 8 weeks to reduce risk of splenic rupture

185
Q

Different types of leprosy?

A

Low degree of cell mediated immunity -> lepromatous leprosy

  • Extensive skin involvement
  • Symmetrical nerve involv

High degree of cell mediated immunity -> tuberculoid leprosy

  • Limited skin disease
  • Asymmetrical nerve involvement -> hypesthesia
  • Hair loss
186
Q

Treatment of leprosy?

A

TRIPLE therapy: rifampicin, dapsone and clofazimine

DRC

187
Q

What causes leprosy?

A

Mycobacterium leprae

188
Q

How to treat toxoplasmosis in non IC patients?

A

often asymptomatic and self-limiting (similar to EBV)

189
Q

What is the disseminated gonococcal infection triad?

A

tenosynovitis, migratory polyarthritis, dermatitis

190
Q

What is the difference between T1 + T2 HIV?

A

Type 1: causes the majority of infections
Type 2: mostly seen in West Africa (lower transmission and progression)

191
Q

What type of virus is HIV?

A

RNA retrovirus

192
Q

When should you start ARVs if Dx with HIV antenatally?

A

At the end of the 1st trimester

193
Q

In what circumstance can you consider a vaginal delivery?

A

Viral load is measured every 2 weeks from 30 wks, if undetectable can consider a vaginal delivery, if not C-section (zidovudine infusion should be started 4hrs before beginning op)

194
Q

What treatment should the newborn be started on and for how long?

A

Post-natally infant started on triple AZT for 4 weeks + exclusive bottle formula feeds
If mothers viral load <50, may only be started on zidovudine

195
Q

Investigations in HIV?

A

HIV Ab test

  • Consists of a screening test (ELISA) and confirmatory test (Western Blot Assay)
  • Abs can be identified from 4 weeks after infection, 99% by 3 months
  • After initial negative result, offer repeat at 12 weeks

P24 antigen test

  • +ve from 1-4 weeks after infection
  • If testing during suspected seroconversion – use this
  • Sometimes used as an additional screening tool in blood banks
196
Q

What is used to monitor HIV?

A

CD4 count and viral load – used to establish how advanced the disease is/monitor treatment

197
Q

Which category of medications should you use two of in the treatment of HIV? And an example?

A

nucleoside reverse transcriptase inhibitors (NRTIs)
Tenofovir

198
Q

SE of NRTIs and tenofovir specifically?

A

SE: peripheral neuropathy
Tenofovir specific: renal impairment, osteoporosis

199
Q

What is an example of a Non-nucleoside reverse transcriptase inhibitors (NNRTIs)? and what are their SEs?

A

Nevirapine
SE: P450 enzyme inducers

200
Q

What is an example of a protease inhibitor? And SEs?

A

Indinavir (end with navir)
SE: diabetes, hyperlipidaemia

(PIs inhibitor the glucose transporter Glut 4 leading to hyperglycaemia)

201
Q

What is an example of an integrate inhibitor?

A

Raltegravir
block the action of integrase, a viral enzyme that inserts the viral genome into the DNA of the host cell

202
Q

Who can be given HIV post-exposure prophylaxis?

A

can be given to patients who are HIV seronegative and have had a high risk exposure (4 week course with follow-up HIV testing) – can be taken up to 72 hours after the event

203
Q

What causes a Kaposi’s sarcoma?

A

HHV-8

204
Q

How does a Kaposi’s sarcoma present?

A

Purple papules on the skin/mucosa, may ulcerate
May be massive haemoptysis + pleural effusion

205
Q

How to treat Kaposi’s sarcoma?

A

Radiotherapy + resection

206
Q

Symptoms of cryptosporidiosis?

A

Watery diarrhoea

207
Q

Diagnosis and treatment of cryotsporidiosis?

A

Dx: modified Ziehl-Neelsen stain of stool may reveal red cysts
Treatment is supportive
Can use nitazoxanide for IC patients

208
Q

Investigations for toxoplasmosis?

A

Ab test, Sabin-Feldman dye test, MRI (multiple ring shaped contrast enhanced lesions – account for 50% of cerebal lesions in HIV)

209
Q

How to treat cryptococcus meningitis?

A

Amphotericin B + flucytosine

210
Q

Cause and effect of progressive multifocal leukoencephalopathy?

A

Secondary to the JC/BK virus
Widespread demyelination

211
Q

Associated condition, CT result and treatment of primary CNS lymphoma?

A

Accounts for around 30% of cerebral lesions
Associated with EBV
CT: single/multiple homogenous enhancing lesions
Mx: steroids + chemo

212
Q

Symptoms and treatment of Mycobacterium avian intracellulare?

A

Fever, SOB/cough, abdo pain/diarrhoea
Tx: rifampicin + ethambutol + clarithromycin

MAI REC

213
Q

Symptom and effect + Tx of cytomegalovirus?

A

Blurred vision
Clinical diagnosis
‘Pizza’ retina – haemorrhages + necrosis
Tx: IV ganciclovir

214
Q

Mechanism of action of aciclovir?

A

DNA polymerase inhibitor
Polymerase is responsible for DNA replication

215
Q

Where can you catch leptospirosis from?

A

Contact with infected rat urine
Common in sewage workers, farmers, vets + people who work in abattoirs
However far more common in the tropics + returning travellers

216
Q

What occurs in the early phase of leptospirosis?

A

Early phase – due to bacteraemia (1 week)
Mild fever
Flu-like symptoms
Subconjunctival haemorrhage

217
Q

What occurs in the second phase of leptospirosis?

A

Second phase – can lead to more severe disease (Weil’s disease)
Acute kidney injury (seen in 50% of patients)
Hepatitis: jaundice, hepatomegaly
Aseptic meningitis

218
Q

What are the investigations in leptospirosis?

A

Serology: Abs to Leptospira develop after about 7 days
PCR
Culture
- Growth may take several weeks so limits usefulness

Use blood/CSF for first week
Then urine cultures from second week onwards

219
Q

What are the live vaccines?

A

You Musn’t Prescribe BCG Incase They RIP, Shit.

BCG, MMR, influenza, rotavirus PO, polio PO, yellow fever, typhoid PO, shingles

220
Q

What causes amoebiasis?

A

Entamoeba histolytica (an amoeboid protozoan)

221
Q

How is amoebiasis spread?

A

Faecal-oral route

222
Q

What is amoebic dysentery?

A

Profuse, bloody diarrhoea

223
Q

How to investigate amoebic dysentery?

A

Hot stool (examined within 15 minutes, may show trophozoites)

224
Q

How to treat amoebic dysentery?

A

Metronidazole

225
Q

What is an amoebic liver abscess?

A

Usually single mass in the right lobe - contents described as ‘anchovy sauce’

226
Q

How to investigate for amoebic liver abscess?

A

Positive serology >90%

227
Q

How to treat amoebic liver abscess?

A

Metronidazole, followed by luminal amoebicide to eradicate the cystic stage

228
Q

Which antibiotics inhibit cell wall synthesis?

A

Beta-lactams (penicillins, cephalosporins, carbopenems)
Glycopeptides (vancomycin/teicoplanin)

229
Q

Which antibiotics inhibits nucleus acid synthesis? ie: inhibit folate synthesis, inhibit DNA gyrase, bind to RNA polymerase, damage DNA?

A

Inhibit folate synthesis -> trimethoprim + sulphonamides (sulfamethoxazole)
Inhibit DNA gyrase -> fluoroquinolones (cipro/levo/ofloxacin)
Bind to RNA polymerase -> rifampicin
DNA strand breaks -> metronidazole

230
Q

Which antibiotics inhibit protein synthesis?

A

Chloramphenicol
Macrolides - clarithro/erythromycin
Tetracyclines - tetracycline/doxycycline
Aminoglycosides - gentamycin, streptomycin

231
Q

Which antibiotics are bacteriostatic?

A

CORe - ChlORamphenicol
Medical - Macrolides
TRAinee - TeTRAcycline
to
SPecialty - SulPhonamide
TRaInee - TRImethoprim

232
Q

What is Hydadtid disease, who gets it and how to Tx?

A
  • Caused by dog tapeworm Echinococcus granulosus
  • Dog ingests hydatid cysts from sheep liver
  • © farmers
  • May cause liver cysts
  • Management: albendazole
233
Q

What is Immune reconstitution inflammatory syndrome?

A

IRIS is an exaggerated immune response to a pre-existing opportunistic infection in HIV patients who commence antiretroviral therapy

234
Q

What skin/vascular changes might you get with Hep B?

A

Urticaria
Polyarteritis nodosa

235
Q

On checking Hep B level after vaccination, how would you interpret the results?

A

>100 - protected
10-100 - give another shot of the vaccine
<10 - repeat all 3 doses. if still not covered then would been Ig if exposed

236
Q

What type of virus is Dengue fever?

A

Flavivirus

237
Q

What is the incubation period for Dengue fever?

A

7 days

238
Q

What transmits Dengue fever?

A

Aedes aegypti mosquito

239
Q

What are the three classifications for Dengue fever?

A
  • Dengue without warning signs
  • Dengue with warning signs
  • Severe dengue
240
Q

What are the symptoms of dengue without warning signs?

A

o Fever, headache (often retro-orbital)
o Myalgia, arthralgia
o Pleuritic pain
o FACIAL FLUSHING
o Maculopapular RASH
o Haemorrhagic manifestations – positive tourniquet test, petechiae, purpura etc

241
Q

Warning signs in Dengue?

A

Abdo pain
Hepatomegaly
Persistent vomiting
Clinical fluid accumulation (ascites, pleural effusion)

242
Q

Symptoms of severe Dengue?

A

A form of DIC resulting in:
- Thrombocytopaenia
- Spontaneous bleeding
Around 20-30% go on to develop dengue shock syndrome (DSS)

243
Q

Blood results in Dengue and other diagnostic tests?

A

Leukopaenia + thrombocytopaenia
Raised aminotransferases

Serology
NAAT testing for viral RNA
NS1 antigen test

244
Q

How to treat Dengue fever?

A

Entirely symptomatic treatment – no antivirals available

245
Q

When do you not need to give a tetanus vaccine to patient with a wound caused by metal?

A

If a patient has had 5 doses of tetanus vaccine, with the last dose < 10 years ago, they don’t require a booster vaccine nor immunoglobulins, regardless of how severe the wound is

246
Q

Treatment/tests involving Interferon-alpha/Interferon-beta/Interferon-gamma?

A

Interferon-alpha -> Hep B treatment
Interferon-beta -> Multiple sclerosis treatment
Interferon-gamma -> TB test

247
Q

What is the MOA of linezolid and what are the SEs?

A

a type of oxazolidinone antibiotic which has been introduced in recent years. It inhibits bacterial protein synthesis by stopping the formation of the 50s initiation complex and is bacteriostatic in nature

Highly active against resistance staph aureus bugs

SE: thrombocytopaenia
monoamine oxidase inhibitor: avoid tyramine foods

248
Q

Type of organism causing Japanese Encephalitis, carried by what host, and who is at risk?

A

Most common cause of viral encephalitis in parts of Asia + Western Pacific
Flavivirus transmitted by Culex mosquitos
Breeds in rice paddy fields, or interaction with birds or pigs

249
Q

Features of Japanese Encephalitis?

A

Majority asymptomatic
Headache
Fever
Seizures, confusion
Parkinsonian features indicate basal ganglia involvement
Can also present with acute flaccid paralysis

250
Q

Diagnosis and management of Japanese Encephalitis?

A

Dx: Serology/PCR
Mx: Supportive

251
Q

What should you not prescribe with trimethoprim?

A

Methotrexate

252
Q

How to treat non-specific urethritis?

A

Azithromycin or doxycycline

253
Q

What is C. perfringens + symptoms?

A

Clostridium spp that produces alpha-toxin which causes gas gangrene and haemolysis

  • features: tender, oedematous skin with haemorrhagic blebs/bullae
  • often crepitus can be heard on movement
254
Q

What is C. botulinum, where found and symptoms? Treatment?

A
  • seen in canned foods/honey, also from IVDU
  • toxin produced prevents Ach release
  • leading to flaccid paralysis, diploplia, ataxia
  • Tx: antitoxin if given early, supportive care
255
Q

What causes C. difficile and complication?

A

Occurs following broad-spectrum antibiotics which disrupt normal gut flora and allow C. diff to over-colonise

256
Q

Which abx can cause C. difficile?

A

Cephalosporins
Co-amoxiclav
Ciprofloxacin
Clindamycin
Carbapenem

257
Q

Symptoms of C. difficile?

A

Typically 3-9 days post-abx
Produces an exotoxin which causes intestinal damage -> pseudomembranous colitis
Diarrhoea – green foul-smelling
Abdo pain
Raised WCC
Toxic megacolon may develop

258
Q

What are the rare complications from an infection with Clostridium sordellii?

A

is a very rare cause of post-partum and post-termination sepsis

259
Q

What is a granuloma inguinale?

A

Caused by Klebsiella granulomatis
causes a painless, red lump on or near the genitals, which slowly enlarges, then breaks down to form a sore
Tx: Azithromycin

260
Q

What percentage of adults don’t respond to 3x Hep B vaccine?

A

10-15%

261
Q

Who should have their blood checked for Hep B antibodies after 3x doses?

A

testing for anti-HBs is only recommended for those at risk of occupational exposure (i.e. Healthcare workers) and patients with chronic kidney disease

262
Q

Who typically catches CMV?

A
  • IC patients
  • HIV
  • Patients on immunosuppressants following organ transplantation (e.g. kidney)
263
Q

What would you see on microscopy in CMV?

A

‘Owl’s eye’ appearance – intranuclear inclusion bodies

264
Q

What are the different presentations of CMV?

A

Congenital – growth retardation, ‘blueberry muffin’ skin lesions, microcephaly
CMV mononucleosis – infectious mononucleosis-like illness
CMV retinitis – common in HIV pts with low CD4, presents with blurred vision, fundoscopy shows retinal haemorrhages and necrosis, often called ‘pizza’ retina, Tx = IV ganciclovir
CMV encephalopathy – seen in pts with HIV who have low CD4 counts

265
Q

What organism causes anthrax and how is it spread?

A

Caused by Bacillus anthracis
Spread: infected carcasses

266
Q

What are the features and management of anthrax?

A

Features
Painless black eschar
May be marked oedema
Can cause GI bleeding

Mx: Ciprofloxacin

267
Q

What organism causes typhoid?

A

Salmonella

268
Q

Presentation of typhoid?

A

Initially systemic – headache, fever, arthralgia
Bradycardia
Abdo pain/distention
Constipation
Rose spots: present on trunk

269
Q

Complciations of typhoid?

A

Osteomyelitis
GI bleed/perforation
Meningitis etc

270
Q

If pen allergy, what should you give in cellulitis?

A

Clarithromycin/erythromycin/doxycycline

271
Q

If untreated, how many people can be infected from 1 TB patient each year on average?

A

If left untreated, 1 person with active pulmonary TB may infect as many as 10 to 15 people every year

272
Q

Sites of extra pulmonary TB?

A
  • CNS (tuberculous meningitis – most serious)
  • Vertebral bodies (Pott’s disease)
  • Cervical LNs
  • Kidneys
  • GI tract
273
Q

TB treatments?

A

Start Tx before culture results if clinically suspected

6m: Isoniazid
6m: Rifampicin
2m: Ethambutol
2m: Pyrazinamide

274
Q

SEs of isoniazid + prevention?

A

peripheral neuropathy (prevent with pyridoxine)

275
Q

SE rifampicin?

A

urine/sweat discolouration

276
Q

SE ethambutol?

A

optic neuritis, need baseline eye check before

277
Q

SE pyrazinamide?

A

arthralgia/liver toxicity

278
Q

How to Tx CNS TB?

A

1 year (extend isoniazid and rifampicin for 12 months)

279
Q

How long to Tx MDR TB?

A

For 24 months
Use NAT test to see which drugs are resistant

280
Q

Complications of TB?

A

Pleural effusion
Empyema
Pneumothorax
Laryngitis
Cor pulmonale secondary to extensive fibrosis

281
Q

Meningitis 0-3 months?

A
  • Group B Streptococcus (most common cause in neonates)
  • E. coli
  • Listeria monocytogenes
282
Q

Meningitis 3 months - 6 yrs?

A
  • Neisseria meningitidis (meningococcus)
  • Streptococcus pneumoniae (pneumococcus)
  • Haemophilus influenzae
283
Q

Meningitis 6 yrs - 60 yrs?

A
  • Neisseria meningitidis
  • Streptococcus pneumoniae
284
Q

Meningitis >60 yrs?

A
  • Streptococcus pneumoniae
  • Neisseria meningitidis
  • Listeria monocytogenes
285
Q

CSF in bacteria/virus/TB?

A

See chart

286
Q

How to treat meningitis empirically in different age groups?

A

Age <3 months – IV cefotaxime + amoxicillin
Age 3m-50yrs – IV cefotaxime
Age >50yrs – IV cefotaxime + amoxicillin

287
Q

How to treat listeria meningitis?

A

IV amoxicillin + gentamicin

288
Q

IV dexamethasone to reduce risk of neurological complications in meningitis, except in?

A
  • Septic shock
  • Meningococcal septicaemia
  • Immunocompromised
  • Meningitis following surgery
289
Q

Prophylaxis/contact tracing

A

PO ciprofloxacin (single dose) or rifampicin
Contact risk highest in first 7/7, persists for 4/52
Meningococcal vaccine to close contacts (incl booster doses) once serology known
If pneumococcal meningitis – no prophylaxis generally needed

290
Q

Complications of meningitis?

A

Neurological sequalae
- Sensorineural hearing loss (most common)
- Seizures
- Focal neurological deficit
- Infective (sepsis/intracerebral abscess)
- Pressure (brain herniation/hydrocephalus)
Patients with meningococcal meningitis -> at risk of Waterhouse-Freiderichsen syndrome

291
Q

Presentation of cutaneous leishmaniasis?

A

Crusted lesions at site of bite
May be underlying ulcer
If acquired in S/central America – needs to be Tx d/t risk of mucocutaneous type
If acquired in Africa/India – can be managed more conservatively

292
Q

Presentation of mucocutaneous leishmaniasis?

A

Skin lesions that may spread to involve the mucosae of the nose/pharynx

293
Q

Presentation of visceral leishmaniasis?

A

(kala-azar, meaning black sickness d/t skin colour)
Occurs in Mediterranean, Asia, S America, Africa
Sx: fever, sweats, rigors
Massive splenomegaly, hepatomegaly
Poor appetite and WL
Grey skin
Pancytopaenia 2* to hypersplenism

294
Q

Type of virus causing rubella?

A

Togavirus

295
Q

Rubella incubation period?

A

14-21 days

296
Q

Rubella infectious period?

A

7/7 before symptoms -> 4/7 of rash

297
Q

Congenital rubella syndrome symptoms?

A
  • Sensorineural deafness
  • Congenital cataracts
  • Congenital heart disease
  • Growth retardation
  • ‘salt and pepper’ chorioretinitis
  • Cerebral palsy
    Foetus most at risk in first 8-10 weeks of pregnancy (up to 90%)
298
Q

Management of rubella?

A

Discuss with local Health Protection Unit
No longer routinely checked at booking visit
Off MMR in post-natal period (do not give during/before pregnancy)

299
Q

Infectious period for slapped cheek syndrome?

A

Infectious for 3-5 days BEFORE rash develops

300
Q

Features of slapped cheek syndrome?

A

May only be mild fever
May develop red cheeks
- Peaks after a week then fades
- May reappear in following months following hot bath/fever/sunlight

301
Q

Features of staph toxic shock syndrome?

A

Reaction to staphylococcal exotoxins (TSST-1 superantigen toxin)
Fever, hypotension, diffuse erythematous rash with desquamation, involvement of 3+ organs

302
Q

Zika vector?

A

Aedes mosquito

303
Q

Features of Zika?

A
  • Majority asymptomatic
  • Otherwise mild (2-7d)
    o Fever, rash, arthralgia/myalgia, conjunctivitis, headache, retro-orbital pain
304
Q

Complications of Zika?

A

Serious complications in adults are uncommon
Has been associated with Guillain-Barre syndrome
Can cause microcephaly/congenital abnormalities in foetus

305
Q

Type of virus and vector for Chikungunya?

A

Alphavirus
Caused by infected mosquitoes
Africa, Asia, Indian continent

306
Q

Symptoms and treatment for Chikungunya?

A

Sever joint pain
Abrupt onset high fever
General flu-like illness
Similar to Dengue but more emphasis on joint pain +/- swelling

No specific treatment

307
Q

What causes Melioidosis (Whitmore’s disease)?

A

gram -ve Burkholeria pseudomallei

308
Q

Incubation for Melioidosis (Whitmore’s disease)?

A

1-21 days (mean 9 days)

309
Q

Transmission of Melioidosis (Whitmore’s disease)?

A

Contact with soil and fresh water

310
Q

Features of Melioidosis (Whitmore’s disease)?

A

Can be acute, chronic, or reactivation of latent infection

Acute pulmonary infection ©
Localised skin infection
Visceral abscesses: prostate, spleen, kidney, liver
Disseminated infection: fever + septic shock, occurs in 55% of cases

311
Q

Ix in Melioidosis (Whitmore’s disease)?

A

Culture – sputum/abscess pus
CXR – pneumonia

312
Q

Tx of Melioidosis (Whitmore’s disease)?

A

IV ceftazidime, imipenem or meropenem 10-14 days
Followed by eradication therapy: oral TMP/SMX (plus doxy) for 3-6 months
May need abscess drainage

313
Q

Mx of scarlet fever?

A

Penicillin V for 10 days
Notifiable disease
Can return to school 24hrs after commencing abx

314
Q

Organism causing diphtheria?

A

Corynebacterium diphtheriae
Releases an exotoxin -> inhibits protein synthesis

315
Q

Features of diphtheria?

A

Pharyngitis + Bradycardia = Diphtheria

Sore throat with a ‘diphtheric membrane’ on tonsils caused by necrotic mucosal cells
Bulky cervical lymphadenopathy
Heart block
Neuritis e.g. CNs

316
Q

Investigation in diphtheria?

A

Throat swab culture

317
Q

Management in diphtheria?

A

IM penicillin
Diphtheria antitoxin

MRCP (14 decks)

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