Infectious diseases Flashcards
1
Q
Acute pyelonephritis m/c causative organism
A
E.coli
2
Q
Amoebiasis
route of transmission
treatment antibiotic
A
Faecal-oral
Metronidazole
3
Q
Animal bites - Pasteurella multocida
Tx antibiotic?
if penicillin allergic:
A
Co-amoxiclav
Doxycycline + metronidazole
4
Q
Human bites - strep,staph,eikenella,fusobacterium,prevotella
Tx antibiotic?
if penicillin allergic:
A
Co-amoxiclav
Doxycycline + metronidazole
5
Q
Examples of antibiotics which are PROTEIN SYNTHESIS INHIBITORS
A
Aminoglycosides Tetracyclines Chloramphenicol Clindamycin Macrolides
MALT Macrolides Aminoglycosides Lincosamides Tetracyclines
6
Q
Aspergilloma - mass like fungus ball.
occurs secondary to?
features:
Ix:
A
Tuberculosis, lung cancer or cystic fibrosis
Cough, haemoptysis
Chest x-ray containing a rounded opacity. A crescent sign may be present
High titres Aspergillus precipitins
7
Q
Bacillus Cereus - Gram +ve/-ve? assoc w/ what food: time of onset: typically resolves in: Mx:
A
Gm +ve ROD Under-cooked or reheated rice 0.5-6 hours 24 hours rarely required for food poisoning however - VANCOMYCIN = AB of choice.
8
Q
Management of bacterial vaginosis:
Adverse effects on pregnancy?
A
Oral metronidazole 5-7 days
Increased risk of preterm labour, low birthweight and chorioamnionitis, late miscarriage
9
Q
Bed bugs:
Infesting organism:
Treatment to control itch?
A
Cimex hemipteru
topical hydrocortisone
10
Q
Clostridium botulinium - releases botulinum toxin which blocks the release of acetylcholine
Describe:
Treatment:
A
Gram positive anaerobic bacillus
Botulism antitoxin and supportive care
11
Q
Camplyobacter - the commonest bacterial cause of infectious intestinal disease in UK Describe: Spread: Incubation period: Treatment: complications:
A
Gm -ve bacillus
Faecal-oral route
1-6 days
Self-limiting but if AB is required - CLARITHROMYCIN is given (if severe symptoms)
Guillain-Barre, reactive arthritis, septicaemia endocarditis
12
Q
Cat scratch disease organism:
A
Bartonella Henselae
13
Q
Cellulitis ABs:
mild/moderate
severe
A
FLUCLOXACILLIN = first line for mild/moderate
CLARITHROMYCIN (erythromycin in pregnancy) or doxyxycline if allergic to penicillin
Co-amoxiclav,
cefuroxime,
clindamycin,
ceftriaxone if severe
14
Q
Chancroid organism:
painful genital ulcers assoc with unilateral painful lymph node enlargement
A
Haemophilus ducreyi
15
Q
Who should get Varicella Zoster Ig (VZIG) prophylaxis
A
1) Significant exposure to chicken pox or herpes zoster
2) condition that increases risk of severe varicella
3) No antibodies to Varicella virus
16
Q
Chlamydia Investigation of choice:
Samples tested with this method?
A
Nuclear acid amplification test (NAATs)
Urine (first void sample), vulvovaginal swab or cervical swab
17
Q
When should chlamydia testing be carried out post-possible exposure
A
2 weeks after
18
Q
Management of Chlamydia:
if pregnant?
A
1) Doxycycline (7 days)
2) Azithromycin (1 day)
Azithromycin, erythromycin or amoxicillin may be used
19
Q
Partner notification chlamydia:
Men with symptoms:
Women and asymptomatic men:
A
Men with symptoms: all contacts since and in four weeks prior to onset of symptoms
Women and asymptomatic men = last 6 months or the most recent sexual partner
20
Q
Cholera
Gram?
hyper/hypoglycaemia?
Mx?
A
Gram-negative
Hypoglycaemia
oral rehydration therapy
antibiotics: doxycycline, ciprofloxacin
21
Q
Gram positive RODS (bacilli) - ABCD L
A
Actinomyces Bacilus anthracis (anthrax) Clostridium Diptheria Listeria Monocytogenes
22
Q
Gram negative rods = the rest
A
E.coli Haemophilus Influezae Pseudomonas aeruginosa Salmonella sp Shigella Campylobacter
23
Q
Gram negative cocci?
A
Neisseria meningitidis, gonorrhoeae, morxella catarrhalis
24
Q
Cryptosporidiosis - the commonest protozoal cause of diarrhoea in the UK
Diagnosis:
Management:
A
STOOL: Modified Ziehl Neelsen stain (acid-fast) may reveal red cysts
Supportive for most
Nitazoxanide for immunocompromised pts
25
```
Severe Dengue (dengue haemorrhagic fever)
blood tests results:
```
Thrombocytopenia, leukocytopenia, raised amino transferases
26
Diptheria:
Investigation:
Treatment:
Investigation: Culture of throat swab
Treatment: IM penicillin, diptheria antitoxin
27
Which is the only DNA virus that is NOT double stranded
Parvovirus
28
Commonest cause of Viral meningitis in adult population:
Enteroviruses
29
Malignancies assoc. with EBV infection:
| 4
Burkitts lymphoma
Hodgkins lymphoma
nasopharyngeal carcinoma
HIV associated Nervous system lymphomas
30
Gastroenteritis causes: Which infection px. w/
Commonest cause of travellers diarrhoea
Watery stools
Abdominal cramps a nausea
E.Colii
31
Gastroenteritis causes: Which infection px. w/
| Prolonged non bloody diarrhoea
Giardiasis
32
Gastroenteritis causes: Which infection px. w/
Profuse watery diarrhoea
severe dehydration resulting in wt. loss
not common amongst travellers
Cholera
33
Gastroenteritis causes: Which infection px. w/
Bloody diarrhoea
vomiting and abdominal pain
Shigella
34
Gastroenteritis causes: Which infection px. w/
severe vomiting
short incubation period
Staphylococcus aureas
35
Gastroenteritis causes: Which infection px. w/
Flu-like prodrome followed by crampy abdominal pain, fever and diarrhoea which many be bloody.
complications include Guillane Barre
Campylobacter
36
Gastroenteritis causes: Which infection px. w/
Two types of illness:
Vomiting within 6 hours (due to rice)
diarrhoeal illness occurring after 6 hours
Bacillus Cereus
37
Gastroenteritis causes: Which infection px. w/
| GRADUAL onset bloody diarrhoea, abdominal pain and tenderness that may last for several weeks?
Amoebiasis
38
```
Incubation periods: Gastroenteritis organisms
1-6 hours
12-48 hours
48-72 hours
>7days
```
1-6 hours: Staph aureas, bacillus cereus
12-48 hours: salmonella, E.coli
48-72 hours: shigella, campylobacter
>7days: giardiasis, amoebiasis
39
Genital herpes:
Investigation of choice?
Management of choice?
Now NAAT - considered superior to viral culture
General measures: saline bathing, analgesia, topical anaesthetic - lidocaine
Some patient with frequent exacerbations may benefit from long term aciclovir.
40
Pregnant women with primary herpes attack - what is advised re delivery if greater than 28 weeks gestation?
Elective C-section at term
41
HPV types:
Genital warts:
Cervical cancer:
Genital warts: 6 & 11
| Cervical cancer: 16,18,33
42
Genital warts management:
1) Topical podophyllum or cryotherapy
| 2) imiquimod cream is second line
43
Giardiasis investigations:
| Treatment: (AB)
Stool microscopy - for trophozoite and cysts
Stool antigen detection assay (greater sensitivity and faster turn around time).
Metronidazole
44
Gonorrhoea AB of choice:
| if IM refused?
Single dose of IM CEFTRIAXONE
Cephalosporins now - used to be ciprofloxacin
If IM ceftriaxone is refused, oral cefixime (400mg) PLUS oral azithromycin (2g) should be used,
45
Most common cause of septic arthritis in young adults:
Gonorrhoea
46
Hepatitis A:
Is there an increased risk of hepatocellular cancer?
Vaccine available?
Who should be vaccinated?
No
Yes
people travelling to or going to reside in areas of high or intermediate prevalence, if aged > 1 year old
people with chronic liver disease
patients with haemophilia
men who have sex with men
injecting drug users
individuals at occupational risk: laboratory worker; staff of large residential institutions; sewage workers; people who work with primates
47
Hepatitis B:
Features:
complications?
Management:
Fever, jaundice and elevated liver transaminases
Chronic hepatitis
Fulminant liver failure
Hepatocellular carcinoma
glomerulonephritis
Only tx. is Peg Interferon ALPHA.
48
```
Hepatitis C:
Features (30%)
At risk:
Vaccine?
investigation to rule out acute infection:
```
Can it lead to chronic infection?
Transient rise in serum aminotransferases/jaundice
Fatigue
Arthralgia
IVDU, pts. who received a blood transfusion before 1991
NO
HCV RNA
Yes, for majority of patients it will (C for chronic)
49
Chronic Hep C complications:
Rheumatological problems:
eye problems:
Liver problems:
Cancer:
Arthralgia, arthritis
Sjogrens syndrome
cirrhosis
Hepatocellular carcinoma
50
Hep C treatment:
Combination of protease inhibitors: Daclatasvir + sofosbuvir with or without RIBAVIRIN
51
Side effects:
Ribavirin:
IFNa:
Ribavirin - Hemolytic anaemia, cough, women should not become pregnant within 6 months of stopping ribavirin as it is teratogenic
IFNa - flu like symptoms, depression, fatigue, leukopenia, thrombocytopenia
52
```
Herpes simplex virus:
Management:
Gingivostomatitis
Cold sores:
Genital herpes:
```
Gingivostomatitis: Oral aciclovir, chlorhexidine mouthwash
Cold sores: topical aciclovir
Genital herpes: oral aciclovir
53
Antiretroviral therapy:
| combination of at least 3 drugs - which are these?
2 NRTI
| Protease inhibitor or NNRTI.
54
NRTI examples:
General side effects:
Zidovudine side effects:
Zidovudine, abacavir, 'VUDINEs", tenofivir
Peripheral neuropathy.
Anaemia, myopathy, black nails
55
Protease inhibitors examples: 'VIRs'
| General side effects:
Indinavir, nelfinavir, ritonavir, saquinavir
diabetes, hyperlipidaemia, buffalo hump, central obesity, P450 enzyme inhibition
56
Integrase inhibitors:
'GRAVIRS'
| relategravir, elvitegravir, dolutegravir
57
HIV complications:
| Toxoplasmosis management
sulfadiazine and pyrimethamine
58
HIV complications:
Primary CNS lymphoma:
Associated with which other virus:
treatment:
EBV
| Steroids, chemotherapy (methotrexate)
59
Pneumocystis Jiroveci pneumonia - the most common opportunistic infection in AIDS:
common complication of PCP
Management (Ix and Tx):
Pneumothorax
CXR, exercise induced desaturation
Sputum.
tx. Co-trimoxazole
IV pentamidine in severe cases.
60
When does HIV seroconversion typically occur?
| how does it present?
3-12 weeks after infection.
| glandular fever-type illness
61
HIV diagnosis:
HIV antibodies - when do they present, how are they found?:
p24 antigen - when is it positive?
What is standard for diagnosis
HIV antibodies: a 4-6 weeks
ELISA (screening) and confirmatory western blot assay.
p24 usually positive from 1 week to 3-4 weeks
Combines HIV abs and p24 test is standard.
62
When should HIV testing in asymptomatic pts. occur?
| when should repeat test be offered?
4 weeks
| 12 weeks
63
HPV vaccine
routine offering is to:
special offering:
BOYS and GIRLS aged 12/13 years
| MSM under the age of 45 to protect against anal, throat and penile cancers
64
EBV - what antibiotic is contraindicated =
Amoxicillin
65
Diagnosis of infectious mononucleosis (EBV)
Heterophil antibody test (monospot) along with FBC - both in the second week of illness
66
Legionella -
causes tachycardia/bradycardia?
Diagnosis?
Treatment
Bradycardia
Urinary antigen
Antibiotics - Erythromycin/Clarithromycin
67
Protozoal infection that can present with increased appetite with paradoxical wt. loss
Leishmaniasis
68
```
Features of which protozoan infection?
Fever, night sweats, rigors
Massive splenomegaly
grey skin,
pancytopenia secondary to hypersplenism
```
Gold standard for diagnosis is bone marrow or splenic aspirate:
Leishmaniasis
69
Organism in Lymes disease:
Borrelia Burgdoferi
70
Can antibiotics be started in Lymes disease based on erythema migrans alone?
YES
71
Condition caused by mycobacterium leprae
types of skin lesion
Treatment:
Leprosy
patches of hypopigmented skin
Rifampicin
Dapsone
Clofazimine
72
Leptospirosis
common in what type of workers?
spread by what animals infected urine?
Ix:
Mx:
sewage workers, farmers, vets, people working in an abattoir
Infected RAT urine.
Serology
PCR
Culture
High-dose benzylpenicillin or doxycycline
73
Lyme disease:
Early feature (skin)
Later features:
ERYTHEMA MIGRANS
CVS: heart block, myocarditis
Neuro: cranial nerve palsies, meningitis polyarthritis
74
Lymphogranuloma Venereum is caused by which STI ?
Typically comprises of 3 stages:
Treated with:
Chlamydia trachomatis servers
L1, L2, L3
1) painless pustule -> ulcer
2) painful inguinal lymphadenopathy
3) proctocolitis
Doxycycline
75
Commonest form of malaria - falciparum or non falciparum?
```
Px:
Schizonts on blood film
Parasitaemia
Hypoglycaemia
Acidosis
Temp > 39 degrees
Severe anaemia
```
Treatment?
Falciparum - also MOST SEVERE
Artemisinin-based combination therapy -
e.g - Artemether, lumefantrine,artesunate,amodiaquine
76
Causes of false Mantoux test:
```
Immunosupression (military TB, AIDS, steroid therapy)
Sarcoidosis
lymphoma
Extremes of age
Fever
Hypoalbuminaemia
```
77
```
Meningitis causes:
0-3 months:
3 months - 6 years:
6 years - 60 years:
>60 years:
Immunosuppressed:
```
0-3 months: Group B strep, e.coli, listeria
3 months - 6 years: Neisseria meningitidis
streptococcus pneumoniae, haemophilus influenzae
6 years - 60 years:
Streptococcus pneumoniae, Neisseria Meningitidis
>60 years: Strep pneumoniae
neisseria meningitidis, Listeria monocytogenes
Immunosuppressed: Listeria monocytogenes
78
Meningitis investigations: (7)
FBC, CRP, Coag screen, blood screen, whole-blood PCR,
Blood glucose, BLOOD GAS
(Lumbar puncture if no signs of increased ICP)
79
```
Meningitis management:
Initial empirical therapy:
<3 months:
>3 months to 50 years:
>50 years:
```
IV cefotaxime plus amoxicillin
IV cefotaxime or ceftriaxone
IV cefotaxime plus amoxicillin
80
Meningococcal meningitis tx:
IV benzylpenicillin or cefotaxime
81
Pneumococcal meningitis tx:
IV cefotaxime or ceftriaxone
82
Meningitis from Haemophilus influenzae tx:
IV cefotaxime or ceftriaxone
83
Meningitis from listeria tx:
IV amoxicillin plus gentamicin
84
IV dexamethasone should be given to reduce the risk of neurological sequelae but withhold if the patient has (4):
Septic shock
Meningococcal septicaemia
Immunocompromised
Meningitis following surgery
85
Does prophylaxis need to offered to household and close contacts of patients with meningococcal meningitis?
If so, what should be used for this?
YES
| Ciprofloxacin or rifampicin
86
Which antibiotic works by forming reactive cytotoxic metabolites inside bacteria:
Metronidazole
87
Antibiotics used in MRSA infection? (3)
Vancomycin, teicoplanin, linezolid
88
Mumps: causative virus?
Infective 7 days before and 9 days after parotid swelling begins
Complications:
RNA paramyxovirus
| Orchitis, hearing loss, meningoencephalitis, pancreatitis
89
Mycoplasma pneumoniae tx. antibiotic:
Doxycycline or a macrolide
90
Necrotising fasciitis:
Type 1 causative organism?
Type 2 causative organism?
T1: mixed anaerobes and aerobes - most common
T2: Strep pyogenes
91
What is the most common prexisting medical condition in necrotising fasciitis:
Diabetes mellitus - especially if tx. with SGLT-2 inhibitor
92
Most common cause of NON-gonococcal urethritis:
second cause:
Antibiotic treatment for this condition:
Chlamydia trachomatis
Mycoplasma genitalium
Oral azithromycin or doxycycline
93
Key distinguishing factor between:
Norovirus and rotavirus (age):
Norovirus and salmonella:
Norovirus and E.coli:
- Rotavirus typically presents in those <5 years
- Salmonella more likely to cause bloody diarrhoea and pts. often have high fever.
- E.coli does cause vomiting and diarrhoea like noravirus but has a longer incubation period (between 3-4 days) but can be up to 10 days. E.coli also causes bloody diarrhoea.
94
Pneumonia typically seen in alcoholics:
| Most common CA pneumonia:
Klebsiella pneumoniae
| Streptococcus pneumoniae
95
Needle stick injury: Order of transmission risk:
| Hep B, Hep C, HIV
Hep B - (20-30%)
Hep C - (0.5%-2%)
HIV (0.3%)
96
A radionucleotide labelled red cell scan is the most sensitive test for which condition:
Hyposplenism.
Howell-Jolly bodies
97
Vaccines which should be received in those having splenectomy (3)
Intervals?
Pneumococcal
Haemophilus Influenza type b
Meningococcal type C
Men C HIs at 2 weeks then booster at 2 years
PPV - 5 yearly interval
98
Prophylaxis in splenectomy:
Penicillin V 500 mg BD or Amoxicillin 250 mg BD
99
Pseudomonas Aeruginosa
| Produces:
Gm -ve ROD
| Produces an endotoxin
100
Pyrexia of unknown origin:
Prolonged fever over how many weeks?
Causes -
Neoplasias:
Infections:
>3 weeks which resists diagnosis after a week in hospital
Neoplasias: lymphoma
hypernephroma, preleukaemia, atrial myxoma
Infections: abscess, TB
101
Antibiotic of choice for Q fever:
Doxycycline
102
Most common cause of bronchiectasis exacerbations:
Haemophilus influenzae
103
Staph aureus pneumonia typically follows which common seasonal virus:
Influenza
104
Adverse effects of rifampicin (4):
Potent CYP450 liver enzyme inducer
Hepatitis
Orange secretions
Flu-like symptoms
105
Lymphadenopathy locations in Rubella:
Suboccipital and post-auricular
106
Gold standard investigation for Schistosomiasis:
Treatment for schistosomiasis
Urine/stool microscopy looking for eggs
one single dose of Praziquantel
107
Components of qSOFA:
RR > 22/min
altered mentation
Systolic blood pressure < 100 mmHg
Score >2 = sepsis
108
Most common bug in spinal epidural abscess?
| Investigations:
Staphylococcus Aureas
Bloods (inflammatory markers, HIV, Hep B, C and coal screen G&S)
Blood cultures
Infection screen: CXR and urine culture
MRI WHOLE SPINE (as skip lesions may be present)
109
Post-splenectomy - at risk infections:
| Think of the vaccination plus one more
Pnemococcus, haemophilus, meningococcus, (vaccines) capnoctyophaga canimorsus:
110
Post-splenectomy vaccinations:
| Antibiotic prophylaxis:
Hib, Men A and C
Annual flu vaccine
Pneumococcal vaccine every 5 years.
Penicillin V
111
Post splenectomy changes:
Which blood product will rise first:
What features will appear on blood film (2)?:
Platelets
| Howell-Jolly Body and Pappenheimer bodies
112
Staphylococcal toxic shock syndrome
```
Diagnostic criteria:
Fever Temperature?
Hypotension - below what?
Rash?
Involvement of how many organ systems?
```
Classic cause:
38.9 degrees
<90 mmHg
Diffuse erythematous rash: especially in the palms and soles
Three
Infected tampons
113
Staphylococcus:
Gm?
Facultative aerobes/anaerobes?
Produce?
Gram-positive cocci
Facultative Anaerobes
Produce catalase
114
Sulphonamides:
MoA:
Examples:
Cotrimoxazole is a combination of which 2 drugs:
Adverse effects (3):
Inhibiting Dihydropteroate synthetase
Sulfamethoxazole
Sulfamethoxazole plus Trimethoprim
Headaches
Rash (SJS)
HYPERKALAEMIA
115
Streptococcus Pyogenes possible antibiotics to treat:
PENICILLIN sensitive still
| macrolide may be used as an alternative.
116
```
Syphilis:
Bug:
Primary phase:
Secondary phase:
Teritary phase:
```
Treponema Pallidum
1) Chancre (painless ulcer), non-tender lymphadenopathy.
2) Systemic features: fevers, lymphadenopathy
Rash on trunk, palms soles, snail track ulcers
3) Neurosyphilis:
Argyll robertson Pupil, ascending aortic aneurysms, tabes dorsalis (neurosyphilis) , granulomas of skin and bone
117
Investigations for Syphilis:
Serological tests divided into:
Non-treponemal tests:
Treponemal tests:
NON-TREPONEMA TESTS (VDRL etc.) ARE CARDIOLIPIN TESTS thus, may get false positives in pregnancy, lupus, APL, TB, HIV etc.
Non-treponemal tests:
VDRL, RPR (rapid plasma reagin)
Treponemal tests: Generally more specific and expensive
T.Pallidium enzyme immunoassay (TP-EIA)
118
Syphilis test results:
Positive non-treponemal test + positive treponemal test =
Positive non-treponemal test + negative treponemal test =
Negative non-treponemal test + positive treponemal test =
Positive non-treponemal test + positive treponemal test
consistent with ACTIVE SYPHILIS INFECTION
Positive non-treponemal test + negative treponemal test
consistent with a false-positive syphilis result
Negative non-treponemal test + positive treponemal test:
consistent with SUCCESSFULLY TREATED syphilis
119
Treatment for syphilis:
alternative antibiotic
Name of reaction seen following treatment
IM Ben Pen is first line
Doxycycline
Jarisch-Herxheimer reaction
120
If antibiotic is to be used in tetanus:
Metronidazole now preferred to benzyl penicillin as first choice
121
Tetanus vaccine: given at which intervals
(3X months, 2X years)
- 5 doses total
```
2 months
3 months
4 months
3-5 years
13-18 years
```
122
Tetracyclines -
MoA:
Indications (4)
Adverse effects-
Can they be given in pregnancy or breast feeding?
Protein synthesis inhibitors: bind to 30s subunit.
Acne vulgaris, lyme disease, chlamydia,mycoplasma pneumoniae
Discolouration of teeth (should not be used in children <12)
Photosensitivity
Angioedema
Black hairy tongue
NO
123
Toxoplasmosis: obligate intracellular protozoan.
Ix of choice (immunocompetent)
tx. of choice (immunocompetent)
HIV/immunosuppressed ix.
mx.
Ix of choice (immunocompetent): Serology
tx. of choice (immunocompetent): No treatment
CT scan
Pyrimethamine plus sulphadiazine for at least 6 weeks
124
Trichomonas vaginalis:
STI or not?
tx.
STI
Oral metronidazole 5-7 days - BNF supports one off dose of 2g metronidazole.
125
Distinguishing features of BV vs trichomonas?
BV: thin, White discharge
microscopy: clue cells
Trichomonas: frothy yellow-green sputum, vulvovaginitis, strawberry cervix
126
Trimethoprim adverse effects (2) :
| folate antagonist
Myelosupression
| Transient rise in creatinine (reversible)
127
Latent TB treatment: 2 options
Meningeal tuberculosis us treated for a prolonged period- how long?
2 options:
3 months of ISONIAZID with pyridoxine and rifampicin or
6 months of ISONIAZID with pyridoxine
treated for a prolonged period - at least 12 months with the addition of steroids.
128
TB drugs A/Es
Rifampicin - potent liver enzyme INDUCER hepatitis, orange secretions, flu-like symptoms
Isoniazid - PERIPHERAL NEUROPATHY (prevent with Pyridoxine B6), hepatitis, liver enzyme INHIBITOR
Pyrazinamide - Hyperuricaemia causing GOUT
ARTHRALGIA, myalgia, hepatitis
Ethambutol - optic neuritis: visual acuity before and during treatment
129
Main test used to screen for latent tuberculosis:
| When is an Interferon gamma test used?:
Mantoux test
If Mantoux test is positive of equivocal
where a tuberculin (Mantoux) test may be falsely negative.
130
```
Diagnosis of active TB, findings -
CXR:
Sputum smear:
Sputum culture:
NAAT:
What is gold standard test?
```
CXR: Upper lobe cavitation = classical finding
bilateral hilar lymphadenopathy
Sputum smear: stained for acid fast bacilli (Ziehl-Neelsen stain)
Sputum culture: GOLD STANDARD - most sensitive, can also assess drug sensitivities
NAAT: allows rapid diagnosis (24-48 hours)
131
Causes of NSU (non-specific urethritis)
Ix.
Mx:
Chlamydia trachomatis
Ureaplasma urealyticum
Mycoplasma genitalium
Urethral swab: gm stained look for leukocytes and Gm-ve diplococci
Chlamydia now increasingly diagnosed using urinary NAATs
Mx: Oral DOXYCYCLINE or single dose Azithromycin
132
UTIs Tx. (NICE)
Non-pregnant women: (when should you also send culture?)
Pregnant women:
Pregnant women asymptomatic bacteriuria:
Trimethoprim or nitrofurantoin for 3 days:
send culture only if > 65 years, haematuria
Urine culture should be sent in all cases:
First line AB: Nitrofurantoin (avoided near term)
second line: Amoxicillin or cefalexin
Urine culture at first antenatal visit plus immediate nitrofurantoin for 7 days.
133
UTIs Men tx:
| Should you treat asymptomatic UTI in catheterised pts.?-
Trimethoprim or nitrofurantoin for 7 DAYS.
| NO, if pt. symptomatic then treat with 7 day ABs
134
Acute pyelonephritis tx:
Cephalosporin or quinolone for 10-14 days
135
Live attenuated vaccines - examples:
Live attenuated:
| BCG, MMR, influenza (intranasal), oral rotavirus, oral polio, yellow fever, typhoid.
136
Inactivated preparations:
Rabies, Hep A, IM Influenza
137
Vancomycin:
Mechanism of action:
Adverse effects:
Inhibits cell wall formation by binding to D-ala-D. Preventing polymerisation of petidoglycans
Nephrotoxicity
Ototoxicity
Thrombophlebitis
Red man syndrome - assoc. with rapid infusions.
138
Viral meningitis:
| Ix.
Pts. should have LP to confirm diagnosis.
139
Yellow fever:
What type of fever:
px:
Cells seen in the hepatocytes:
Haemorrhagic fever
Incubation period = 2-14 days
Classic description + sudden onset of fever, rigors, N&V, bradycardia may develop, brief remission followed by jaundice, haematemesis, oliguria.
Councilman bodies (inclusion bodies) may be seen in the hepatocytes.
140
Legionella typically causes what, with regards to WCC
Lymphopaenia
141
Which commonly prescribed drug may cause a false negative Mantoux test
Steroid therapy
142
Which class of pain-killers should be stopped in C.difficile
Opioids - medications which are ANTI-motility and ANTi- peristaltic should be stopped
