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MCCQE1 > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

Investigations in suspected MRSA?

A

screening cultures

CXR

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2
Q

Management of MRSA?

A

vancomycin/daptomycin/linezolid

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3
Q

Features of C. Diff?

A

fever, nausea, abdo pain, watery diarrhoea

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4
Q

Investigations in suspected C. Diff?

A

stool PCR for toxins A + B

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5
Q

Management of C. diff?

A

vancomycin or fidaxomicin +/- metronidazole (if ileus present)

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6
Q

When should klebsiella pneumonia be considered?

A

Aspiration pneumonia
Alocholics
Abscess in the lungs

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7
Q

Common causes of pneumonia?

A

s. pneumoniae, h. influenzae, s. aureus, GAS

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8
Q

Signs of pneumonia?

A

Consolidation (crackles, dull to percuss, bronchial breath sounds)

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9
Q

Ix pneumonia?

A
  • Bloods
  • serum gram stain (C + S), blood C+S
  • pleural fluid (C+S) IF effusion over >5cm or resp. -distress
  • CXR
  • bronchoscopy/washings if very ill/refractory to Tx
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10
Q

Criteria for hospitalisation w/ suspected pneumonia?

A

CURB 65 or PSI (pneumonia severity Index)

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11
Q

CURB-65 Score

A 
Confusion
Urea 7mmol/L or BUN >20mg/dL 
RR >30 
sBP <90 or dBP <60
age 65+ 
(0-1 point treat outpt, 2-3 consider hospital, 4-5 consider ICU)
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12
Q

Management of CAP?

A

outpt: amoxicillin OR doxycycline OR macrolide (cliarithromycin)
inpatient: Beta lactam (ceftriaxone) +/- macrolide

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13
Q

Management of HAP?

A

piperacilllin - tazobactam

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14
Q

Prevention of pneumonia?

A

pneumococcal polysaccharide vaccine: all adults 65+ or younger pts at high risk for invasive pneumococcal disease

pneumococcal conjugate vaccine for 5-17 yr at high risk and has not received the conjugate vaccine

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15
Q

Types of influenzae strains?

A 
strain A (humans, birds, mammals) 
strain B (humans only)
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16
Q

Features of influenzae?

A

Systemic (fever, chill, myalgia)
Resp (cough, dyspnoea, pharyngitis)
typically resolve 7-10 days

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17
Q

Ix in influenzae?

A

primarily clinical

nasopharyngeal swabs for RT- PCR

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18
Q

Tx of influenzae?

A

Supportive

Neuraminidase Inhibitors (oseltamivir/ zanamivir) - IF severe/high risk for complications

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19
Q

Common causes of cellulitis?

A

B-hemolytic streptococci

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20
Q

Ix cellulitis?

A

CBC + differential
blood C+S
skin swab (if open w/ pus)

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21
Q

Tx cellulitis?

A

cephalexin

consider IV cefazolin

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22
Q

Features of nec fasc?

A

pain out of proportion
edema + crepitus + fever
necrosis

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23
Q

Ix in nec fasc?

A

clinical Dx
blood + tissue C+S
serum CK
X- ray

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24
Q

Tx nec fasc?

A

surgical debridement
IV fluids
IV antibiotics

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25
Q

Features of oral candidiasis?

A

white patches + can be wiped off w/ erythematous base

red patches localised to palate + dorsum of tongue

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26
Q

Tx oral candidiasis?

A

topical antifungals

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27
Q

Features of gonococcal arthritis?

A

arthralgia
bacteremia Fx
pustular skin lesions and migratory arthralgias (if disseminated)

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28
Q

Features of septic arthritis?

A

acute onset, non wt bear, swelling/warmth often in large weight bearing joints + wrists

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29
Q

Ix in septic arthritis?

A

gonococcal: blood C+S, endocervical/urethra/rectal swabs

non-gonococcal: Blood C+S

arthrocenteisis (synovial fluid analysis)
CBC w/ diff
gram strain

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30
Q

Management of septic arthritis?

A

empiric IV: cefazolin +/- vancomycin

gonococcal: ceftriaxone

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31
Q

Management of diabetic food infections?

A

mild/mod: cefazolin/cephalexin

severe: ceftriaxone+metronidazole

optimise glycemic control, pressure offloading, wound care

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32
Q

Causes of infective endocarditis?

A

native valve - streptococcus

IVDU - s. aureus

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33
Q

Fx of infective endocarditis?

A

systemic
cardiac: CHF - MR, AR
embolic/vascular: splinter haemorrhages, janeway lesions, splenomegaly
immune: osler nodes, glomerulonephritis, arthritis

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34
Q

Dx of infective endocarditis?

A

Dukes Criteria
2 major OR 1 major + 3 minor OR 5 minor

MAJOR: all positive blood cultures, evidence of endocardial involvement

MINOR: 
predisposing condition 
fever 
vascular/ immune signs 
positive blood culture
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35
Q

Ix of infective endocarditis?

A

BC x3 (different sites over 1hr apart)
bloods: anemia, ESR increased, RF+
urinalysis + C/S
ECHO: vegetation, regurgitation, abscess

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36
Q

Rx for infective endocarditis?

A

native valve: vancomycin + gentamicin / ceftriaxone

prosthetic valve: vancomycin + gent + rifampin

surgical

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37
Q

When do pts need prophylactic ABx in prev infective endocarditis?

A

if high risk +
dental/respiratory procedure (amoxicillin or clindamycin)

skin/soft tissue procedure (cephalexin or clindamycin)

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38
Q

Common organisms in meningitis (age 0-4 wks)

A

GBS
e. coli
L. monocytogenes

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39
Q

Common organisms in meningitis (age 1-3mo)

A

GBS

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40
Q

Common organisms in meningitis (age >3m)

A

s. pnuemoniae
N. meningitiditis
L. monocytogenes (if over 50 + cormorbid)

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41
Q

Ix in meningitis?

A

CBC, eletrolytes, blood C+S
CSF
imagining/neuro studies if focal neurological signs

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42
Q

Gram stain for S. pneumoniae?

A

Gram + diplococci

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43
Q

Gram stain for N. meningitidis?

A

Gram - diplococci

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44
Q

Gram stain for L. monocytogenes?

A

Gram + rods

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45
Q

CSF findings for bacterial vs viral causes?

A

Bacterial: high protein, low glucose, neutrophils

Viral: high protein, normal glucose, lymphocytes

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46
Q

Management of meningitis (age 0-4 wks)

A

ampicillin + cefotaxime

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47
Q

Management of meningitis (4 wks - <3m)

A

ceftriaxone + ampicillin + vancomycin

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48
Q

Management of meningitis (>3m)

A

ceftriaxone + vancomycin

+ ampicillin (IF RF for L. monocytogenes)

49
Q

When is IV dex used in meningitis?

A

within 20 min prior or w/ 1st dose ABx

continue if proven pneumococcal meningitis

50
Q

Post exposure prophylaxis in meningitis?

A

h. influenzae - rifampin (if not adequately immunized or immunocompromised)
n. meningitidis - rifampicin, ciprofloxacin

51
Q

Rx of encephalitis?

A 
supportive care 
IV acyclovir (until HSV encephalitis ruled out)
52
Q

Features of tetanus?

A

trismus / lockjaw
contraction of skeletal muscle w/ periods of painful muscle spasms
paralysis
HTN/tachycardia/pyrexia

53
Q

Rx of tetatus?

A

wound debridement
IV metronidazole OR IV pen G
tetanus immuneglobulin

54
Q

Prevention of tetanus?

A

toxoid vaccine

55
Q

Management of rabies if not previously immunized?

A

wound care
passive immunization: immunoglobulin
active: inactivated human diploid cell rabies virus vaccine - 4 shots post exposure

56
Q

Management of rabies if previously immunized?

A

wound care

two doses of inactivated human diploid cell rabies virus vaccine

57
Q

qSOFA score

A

RR 22+
systolic BP <=100
GCS <15

58
Q

septic shock definition

A

persistent hypotension requiring vasopresins + serum lactate >2 mmol/L

59
Q

Management of sepsis?

A 
resp support 
CVS support 
IV antibiotics
Source control
Hydrocortisone IV if unresponsive to fluid resus/vasopressors (norepinephrine)
60
Q

Fx of leprosy?

A

chronic granulomatous disease

  • tuberculoid type: less lesions, well defined
  • lepromatous type: multiple lesions, facies
61
Q

Ix in leprosy?

A

skin biopsy for AFB staining

PCR (Mycobacterium leprae)

62
Q

Cause of lyme disease in N. america?

A

Borrelia burgdorferi transmitted by ticks

63
Q

Fx of lyme disease?

A 
BAKE 
Bell's palsy 
arthralgia 
kardiac block 
erythema migrans: non itchy bulls-eye lesion 
(stage 1: rash and malaise) 
(stage 2/3: systemic involvement)
64
Q

Tx of lyme disease?

A

doxycycline

65
Q

Causes of toxic shock syndrome?

A

staphylococcus or streptococcus

66
Q

Rx of toxic shock syndrome MSSA and MRSA?

A

MSSA: clindamycin + cloxacillin

MRSA: clindamycin + vancomycin

67
Q

Rx of toxic shock syndrome streptococcal?

A

penicillin + clindamycin

68
Q

Bug that causes cat scratch disease?

A

Bartonella henselae (GN bacilli)

69
Q

Fx of cat scratch disease?

A

malaise, fever

disseminated: organomegaly, lymphadenopathy, retinitis,IE, encephalopathy, uveitis

70
Q

Tx of cat scratch disease?

A

Azithromycin

71
Q

Cause of rocky mountain spotted fever?

A

Rickettsia rickettsii

72
Q

Fx of rocky mountain spotted fever?

A

flu like prodrome

macular rash d2-4 starting on wrists/ankles then spread centrally

73
Q

Rx of rocky mountain spotted fever?

A

doxycycline

74
Q

Cause of syphilis?

A

treponema pallidum

75
Q

Fx of syphilis?

A

1: chancre
2: maculopapular rash, condylomata lata
3 (tertiary): nodular granulomas, aortic aneurysm/AR
4: neurosyphilis - argyll robertson pupil

76
Q

What is argyll robertson pupil?

A

accomodates but does not react to light

77
Q

Rx for syphilis?

A

Benzathine penicillin G

78
Q

Types of TB?

A

Pulmonary type
Miliary type
Extra-pulmonary

79
Q

Fx of pulmonary TB?

A 
productive cough 
non- resolving pneumonia 
haemoptysis 
night sweats 
wt loss, CP
80
Q

Fx of miliary TB?

A

widely disseminated spread to other organs

81
Q

Ix for latent TB?

A

tuberculin skin test - >10mm induration is + test

82
Q

Ix for active TB?

A
  • CXR: apical infiltrates, lung volume loss, cavitation, Ghon complexes
  • sputum samples: acid fast bacilli smear
    +/- BAL (if other pathology also suspected)
83
Q

Rx of active TB?

A 
RIPE 
Rifampin 
Isoniazid (+ pyridoxine) 
Pyrazinamide 
Ethambutol
84
Q

Primary prevention of TB?

A

BCG vaccine

85
Q

HIV acute infection features?

A

non specific illness

heme: lymphopenia, thrombocytopenia

86
Q

Initial screening test for HIV?

A

ELISA for anti-HIV antibodies (3mo period before detectable)

87
Q

Conformation test for HIV?

A

Western blot

88
Q

Why does the CD4 count and viral load matter in HIV?

A

CD4 - progress and stage of disease

Viral load - rate of progression

89
Q

What vaccines are recommended for HIV+ pts?

A

flu yearly
pnuemococcal every 5 yrs
HBV + HAV if not immune
HPV

90
Q

Overall Rx for HIV + pts?

A

reduce viral load

2NRTIs + 1INSTI or protease inhibitor

91
Q

Ix in Pneumocystis jirovecii pneumonia?

A

CXR: bilat. interstitial infiltrates
ABG: reduced pO2, increased alveloar arterial gradient
serum LDH: elevated
PCR

92
Q

Rx of PJP Pneumonia?

A

trimethoprim - sulfamethoxazole

93
Q

What fungi can be inhaled from pigeon droppings?

A

Cryptococcus neoformans

94
Q

Features of cryptococcus spp?

A 
opportunistic fungi - think HIV
Raised ICP (abducens palsy)
95
Q

Ix of cryptococcus spp?

A

LP and indian ink stain

antigen test

96
Q

Rx of aspergillus spp?

A

voriconazole or amphotericin B

surgical resection if aspergillioma

97
Q

Causes of malaria?

A

plasmodium species

98
Q

Features of malaria?

A

flu like prodrome
high spiking fevers + shaking chills
hepatosplenomegaly + thrombocytopenia without leucocytosis

99
Q

Most lethal type of malaria?

A

Plasmodium falciparum

  • CNS involvement
  • ARDS
  • AKI
100
Q

Ix in malaria?

A

CBC: thrombocytopenia, anemia, elevated LDH
microscopy: blood smear x 3
rapid antigen / PCR

101
Q

Management of malaria?

A

chloroquine

102
Q

Exposure to what causes toxoplasma gondii?

A

cat feces

ingestion of undercooked meat

103
Q

Features of toxoplasma gondii?

A

immunocompetent - mononucleosis like syndrome
immunocompromised - encephalitis
Ring enhancing lesions on CT

104
Q

Ix in toxoplasma gondii?

A

serology
CSF wright-giemsa stain
antigen or PCR

105
Q

Rx in toxoplasma gondii?

A

Trimethoprim -sulfamethoxazole if immunocompromised

106
Q

Features of ascaris lumbricoides?

A

Roundworm

intestinal blockage, pul infiltrates

107
Q

Features of trichuris trichira?

A

whipworm (roundworm)
diarrhoea
abdo pain

108
Q

Features of strongyloids stercoralis?

A

threadworm (roundworm)
pruritic dermatitis
abdominal pain, diarrhea, pruritis ani

109
Q

Rx of roundworms?

A

mebendazole
albendazole
ivermectin

110
Q

What flatworm is found in undercooked pork?

A

Taenia solium

111
Q

What flatworm is found in undercooked beef?

A

taenia saginata

112
Q

What flatworm is found in raw fish?

A

diphyllobothrium latum

common in great lakes

113
Q

Features of diphyllobothrium latum?

A

b12 deficiency

114
Q

Rx of flatworms?

A

Praziquantel

115
Q

What flatworm can be found in fresh water?

A

Schistosoma species

116
Q

Features of schistosoma spp infection?

A 
Swimmers itch 
Acute schistosomiasis (Katayama) - hypersensitivity reaction
117
Q

Features of chronic schistosomiasis infection?

A

Neurological manifestation

Pulmonary manifestation

118
Q

Most common causes in returning traveller?

A

malaria (parasite)
viral - mononucleosis like syndrome, hepatitis
salmonella

MCCQE1 (6 decks)

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