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AA Y4 Finals cards NE > Infectious diseases > Flashcards

Infectious diseases Flashcards

1
Q

which class of antibiotic must be given IV due to poor oral absorption?

A

vancomycin

a glycopeptide

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2
Q

how does the mechanism of action differ between penicillins and macrolides?

A

penicillins act on B lactam of the cell wall- they are bactericidal

macrolides inhibit protein synthesis - they are bacteriostatic

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3
Q

a patient should stop taking their stain if they are on which antibiotic?

A

macrolides

statin + macrolide = increased risk of myopathy

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4
Q

which antibiotic reduces the effect of the COCP?

A

rifampicin

it is a liver enzyme inducer so will increase oestrogen metabolism and reduce contraceptive effect of COCP

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5
Q

name the 4 indications for remaining on IV therapy?

A
  • oral option not available
  • 2 or more symptoms of SIRS
  • febrile w/ neutropenia or immunosupression
  • psot surgery and unable to tolerate 1l oral fluid
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6
Q

what genus causes malaria?

what is the most common form?

A

protozoa

plasmodium falciparum - it is the most common and most likely to cause fulminant disease

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7
Q

what is the carrier of malaria?

A

female anopheles mosquitos

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8
Q

name the 4 main complications that occur if the malaria protozoal infects RBCs?

A
  • cytokine release
  • intravascular haemolysis
  • splenomegaly due to sequestration in the spleen
  • small vessel occlusion and inflammation in the brain via toxin/cytokine release
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9
Q

describe the initial presentation of malaria?

A

flu like prodrome: malaise, myalgia, anorexia

fever: the universal symptom of malaria - usually paroxysmal

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10
Q

what can be found on examination in malaria?

A

splenomegaly

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11
Q

name 6 complications that can occur in malaria?

A

hypovolemia/shock
respiratory: ARDS, oedema

Haem: haemolytic anaemia, DIC

metabolic: hypoglycaemia and metabolic acidosis

CNS: drowsiness, confusion, coma

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12
Q

what diagnostic test is used for malaria?

A

giema stained thick and thin blood smears

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13
Q

how is severe malaria managed?

A

ITU admission

IV artesunate + paraquine

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14
Q

how is non-severe malaria managed?

A

1st line: artemuther + lumefantrine

2nd line: quinine and doxycycline

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15
Q

in addition to malaise, fever and headache, which condition causes GI pain and diarrhoea after the 1st week?

A

typhoid

also causes a rash

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16
Q

describe the rash seen in typhoid fever?

A

scanty, maculo-papular rash, usually on the chest

small pink spots sometimes called rose spots

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17
Q

name the complications that go on to occur if typhoid is left untreated?

A

intestinal perforation

other infections: lobar pneumonia, osteomyelitis, meningitis

these complications will develop within a few weeks if not tx’d

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18
Q

what is the diagnostic Ix for typhoid?

A

blood culture

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19
Q

how is typhoid disease managed?

A

seek AB advice from infectious diseases

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20
Q

what is the causative organism in cholera?

A

gram neg vibrio cholerae

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21
Q

what is the causative agent in typhoid?

A

salmonella typhyi or parathyoid

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22
Q

describe the stools in cholera?

A

profuse, watery, rice like stools

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23
Q

name the investigation done in cholera?

A

stool microscopy and culture

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24
Q

how is cholera managed?

A

rehydration

give rehydrations sachets or IV

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25
Q

what shape is tetanus organism on culture?

A

drumstick shape

causative: clostridium tetani

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26
Q

how does tetanus inoculation always occur?

A

penetrative wounds

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27
Q

describe the typical presentation of tetanus?

A

prodromal: fever and malaise

trismus (lockjaw) followed by full body spastic paralysis

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28
Q

how is tetanus managed?

A

tetanus Immunglobulin

antibiotics: metronidazole and penicillin

sedation, supportive care and surgical debridement

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29
Q

how can tetanus be prevented?

A

the prophylactic vaccine - contains tetanus anti toxin

3 doses given monthly from aged 2 months

boosters given at 4 and 14 years

completion of the 5 doses gives lifelong immunity

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30
Q

compare the length of IV AB Tx needed in an IV drug user if they have a staph aureus infection in a) the blood stream and b) an abscess?

A

blood stream - 2 weeks

abscess - 4-6 weeks

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31
Q

what is 1st line for MRSA?

A

IV vancomycin

it is resistant to flucloxicillin

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32
Q

which additional scan is needed for those with a staph aureus infection?
why?

A

ECHO

needed for endocarditis

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33
Q

what should be done if a patient on the ward presents with norovirus?

A

isolation of patients and ward closure

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34
Q

what is the gold standard diagnostic test for C.Diff?

A

stool toxin

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35
Q

how is amoebiasis treated?

A

metronidazole

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36
Q

what complication can amoebiasis cause?

A

liver abscess

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37
Q

why do people infected with malaria have temperature spikes every 48 hours?

A

the RBCs that are infected with replicating merozoites (malaria) rupture every 48 hours

this releases loads of merozoites into the bloodstream, causing a haemolytic anaemia and temp spike

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38
Q

how many blood samples are sent away for malaria?

why is this the case?

A

3 samples over 3 consecutive days

due to the cyclical nature of malarial merozoites being released every 48 hours

the sample may be neg on the day that the RBCs have not ruptured

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39
Q

what are the 2 main Tx for malaria that you must remember for exams?

A
  1. artesunate

2. quinine

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40
Q

what is the most severe form of malaria and most likely to be seen in the UK?

A

plasmodium falciparum

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41
Q

which antimalarial has the best side effect profile?

how is it taken?

A

malarone

taken 2 days before, during and 1 week after being in an endemic area

most expensive

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42
Q

which antimalarial can cause bad dreams and rarely psychotic disorders or seizures?

A

mefloquine

taken once weekly 2 weeks before, during and 4 weeks after being in endemic area

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43
Q

how is doxycycline taken as an antimalarial?

A

taken daily 2 days before, during and 4 weeks after being in an endemic area

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44
Q

which is the only antimalarial that doesnt have to be taken for 4 weeks upon return from an endemic area?

A

malarone

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45
Q

describe the staining technique used for TB?

why is it needed?

A

TB has a waxy coating that makes it resistant to gram staining

requires a zeihl-neelsen stain

causes acid fast bacilli that stain red with zeihl Neelsen stain

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46
Q

compare buzzwords in multiple myeloma and TB on staining?

A

amyloidosis due to multiple myeloma - shows apple green bifringence on congo red stain

TB- acid fast bacilli staining red on zeihl neelsen

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47
Q

what is the definition of latent TB?

A

when the body’s immune system has encapsulated the area of infection and stopped the progression of TB

it becomes secondary TB when it reactivates

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48
Q

what is miliary TB?

A

when the immune system is unable to control the disease, causing a disseminated, severe disease

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49
Q

why are the lungs the most common site of TB infection?

A

the TB bacteria have high oxygen demands

therefore, the lungs are the easiest place for them to divide

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50
Q

how does TB affect lymph nodes?

A

it causes a ‘cold abscess’

firm, painless abscess in neck lymph nodes, caused by TB

unlike acutely infected abscesses, there is no inflammation, pain or erythema

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51
Q

who receives the BCG vaccine?

A

a live vaccine for TB

offered to those at high risk of contracting TB

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52
Q

what is done prior to a BCG vaccine being administered?

why?

A

mantoux tests - to assess for latent TB

assessed for immunosupression and HIV prior to vaccine as well

this is done as it is a live vaccine - so there is related risks

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53
Q

what is pott’s disease?

A

spinal pain due to spinal TB

54
Q

name the 2 tests that can be done to test for an immune response to TB?

what is considered a positive result in both?

A

Mantoux test - if there is an induration of 5mm or more

interferon- gamma release assay - if there is a release of interferon gamma

55
Q

when would each of the 2 TB tests be indicated in a patient?

A

if mantoux skin test is positive, then do IGRA to confirm a diagnosis of latent TB

56
Q

in addition to the 4 antibiotics for TB (R, I, P, E), what other drugs should be started?
why?

A

start pyridoxine also

pyridoxine is vit B6 - it is prescribed phophylactically to help prevent peripheral neuropathy

peripheral neuropathy is caused by isoniazid

57
Q

which TB med causes peripheral neuropathy?

what should be prescribed to prevent this?

A

isoniazid

co-prescribe pyridoxine

58
Q

how long should patients with TB be isolated until established on Tx?

A

TB patients should be isolated until established on Tx for 2 weeks

59
Q

what other Mx considerations are there for TB?

A

test all contacts

notify public health

test for other infectious diseases (HIV, hep B, hep C)

60
Q

name the side effect associated with rifampicin?

A

red and orange urine

“red-an-orange-pissin” = rifampicin

61
Q

name the side effect associated with isoniazid?

A

peripheral neuropathy

“I-so-numb-azid” = isoniazid

co-prescribe pyridoxine

62
Q

name the side effect associated with ethambutol?

A

colour blindness and reduced visual acuity

“eye-thambutol” = ethambutol

63
Q

what is 1st line Tx for limes disease?

A

orał doxycycline 14-21 days

64
Q

which rash is seen in lymes disease?

A

erythema migrans

65
Q

how is lymes disease investigated?

A

it can be diagnosed clinically if presence of erythema migrans

if no rash, ELISA antibodies to borrelia burgdorferi

66
Q

which 2 ID’s are commonly co-infectious?

A

HIV and TB

if someone presents with one, always check for the other

67
Q

what Ix is done to diagnose suspected active TB in a patient with HIV?

A

suptum culture

HIV significantly reduces the sensitivity of sputum microscopy, so culture must be done

mantoux and IFGA are only used to diagnose latent TB, not active TB

68
Q

what is the most common cause of pneumonia following influenza?

A

staph aureus

69
Q

which cause of pneumonia can cause lymphopenia, deranged LFTs and hyponatremia?

A

legionella pneumonia

spread by air con

70
Q

which atypical pneumonia can chase haemolytic anaemia and erythema multiforme?

A

mycoplasma pneumonia

erythema infectiosum is caused by parvovirus B19, which causes aplastic anaemia

71
Q

why is it important to recognise mycoplasma as an atypical pneumonia?

A

it lacks a peptidoglycan cell wall, so won’t respond to penicillins or cephalosporins

Tx= doxycycline or a macrolide (erythromycin)

72
Q

which med for UTIs should be avoided in breast feeding?

A

nitrofurantoin

73
Q

which hepatitis is particularly associated with travellers?

how is it managed?

A

hep A

Tx is supportive

74
Q

when are nitrofurantoin and trimethoprim considered safe in pregancy?

A

trimethoprim is safe in the last 2 trimesters, not in 1st trimester

nitrofurantoin should be avoided in the 3rd trimester

75
Q

what are the standard tests for diagnosis and screening of HIV?

A

combination tests

HIV p24 antigen + HIV antibody

76
Q

when can post exposure prophylaxis be offered up until in HIV?

A

up to 72 hours post- exposure

77
Q

name 5 live attenuated vaccines?

A 
BCG
polio 
MMR 
yellow fever
oral typhoid
78
Q

what is the Ix of choice in genital herpes?

A

NAAT testing

79
Q

what test is used to assess drug sensitivities in TB?

A

sputum culture

80
Q

which type of hepatitis is known to also cause thrombocytopenia?

how is this type of hepatitis often transmitted?

A

hep E

transmitted via undercooked pork

81
Q

compare the 1st line Ix for testing men and women for chlamydia and gonorrhoea?

A

men: 1st pass urine sample
women: a vulvovaginal swab

82
Q

which ID can cause lactose intolerance?

A

giardiasis

also causes malabsorption - foul smelling stools that float

83
Q

how is giardiasis Tx’d?

A

metronidazole

84
Q

which GI symptom is a big clue towards typhoid?

A

constipation

most other IDs cause diarrhoea

typhoid also cases a maculopapular rash, causing ‘rose spots’

85
Q

what makes up antiretroviral therapy?

A

combination of at least 3 drugs:

2 nucleoside reverse transcriptase inhibitors
PLUS
either,
1 protease inhibitor or
1 non-nuclesoide reverse transcriptase inhibitor

86
Q

when should patients with HIV start on antiretroviral therapy?

A

as soon as they have been diagnosed

dont wait until a particular CD4 count

87
Q

name one general nucleoside reverse transcriptase inhibitor side effect?

A

peripheral neuropathy

88
Q

what type of NIV drug is ritonavir?

A

protease inhibitor

“-navir tease a pro”

89
Q

what class of AB should be given to patients with cellulitis who are allergic to fluclox?

A

macrolides

erythromycin, clarithromycin

erythromycin in pregancy

90
Q

how is a staph aureus gastroenteritis characterised?

A

short intubation period and severe vomiting

91
Q

what accounts for around 50% of cerebral lesions in patients with HIV?

A

toxoplasmosis

CT shows single or multiple ring enhancing lesions

92
Q

what is the most common fungal infection of the CNS?

A

cryptococcus

india ink test positive

93
Q

what are the 2 1st line ABs to give a pregnant patient with UTI who is asymptomatic?

A

amoxicillin or cefalexin

trimethoprim can be used in the 3rd trimester only, but amoxicillin is preferred

nitrofurantoin cant be used in 3rd trimester due to risk of haemolytic anaemia

94
Q

describe post exposure prophylaxis for HIV?

A

consists of oral antiretroviral therapy for 4 weeks

should be started ASAP following the incident but no later than 72 hours following incident

95
Q

what can be given for gonorrhoea if a patient refuses IM ceftriaxone?

A

oral cefixime and oral azithromycin

96
Q

what should all HIV patients with a CD4 count < 200mm/3 be offered?
why?

A

co-trimoxazole

to protect against pneumocystis jiroveci pneumonia

97
Q

what is the investigation of choice in genital herpes?

A

NAAT on swab

98
Q

what is the most common cause of viral meningitis in adults?

A

enteroviruses

ie - coxsackie B virus

HSV 1 more commonly causes encephalitis

HSV 2 causes meningitis but isn’t as common as enteroviruses

99
Q

in an anaemic picture, what is raised unconjugated bilirubin a sign of?

A

haemolysis

100
Q

how is syphilis treated?

A

IM benzathine penicillin

101
Q

describe the typical LFT count in dengue fever?

what other symptoms do they present with?

A

low platelet count

raised transaminase

retro-orbital headache, fever, facial flushing, rash in a retuning traveller

102
Q

what may arise in a lung cavity secondary to previous TB?

A

aspergilloma

XR shows target shaped lesion in the upper lobe with air crescent sign

103
Q

what AB is used as prophylaxis for contacts of patients with meningococcal meningitis?

A

ciprofloxacin or rifampicin

cefotaxime is used to Tx the meningitis, but not prophylactically

104
Q

what is the bacterial causative of a pneumonia with breathlessness, dry cough and erythema multiforme (bullseye rash)

A

mycoplasma pneumonia

105
Q

how is mycoplasma pneumonia diagnosed?

A

serology

106
Q

compare 1st line UTI Tx in a pregnant women depending on if she is symptomatic or not?

A

symptomatic: nitrofurentoin (avoid near term)
asymptomatic: nitrofurantoin or amoxicillin if near term

107
Q

how does rifampicin affect COCP efficacy?

A

it reduces the efficacy of COCP

108
Q

which bacterial causative of pneumonia does a preceding influenza virus predispose to?

A

staph aureus

109
Q

what is 1st and 2nd line used to treat MRSA?

A

1st line: vancomycin

2nd line: linezolid

110
Q

in immunosuppressed patients who have just been exposed to an infectious disease (chickenpox) who aren’t vaccinated against it, what should be given?

Immunoglobulin or vaccination?
why?

A

immunoglobulin - NICE recommends that at risk groups should be given the immunoglobulin as prophylaxis

the vaccine is often contraindicated if it is live attenuated and the Px is immunocompromised. Additionally, the vaccine will not provide protection for exposure that has just occurred

111
Q

why is doxycycline C/I’d in a pregnant women with chlamydia?

what should be given instead?

A

C/I’d due to risk of permanent dental discolouration and enamel hypoplasia in the fetus

give azithromycin or erythromycin instead

112
Q

what is the most common cause of encephalitis?

how does it commonly present?

A

herpes simplex virus most common cause

presents with confused, disoriented patients who are acting oddly/differently

they also show jerking movements, similar to seizures

113
Q

how is legionella pneumonia best diagnosed ?

how does it often present?

A

urinary antigen test

productive cough, fever, hyponatremia and deranged LFTs

114
Q

which hepatitis should be considered in a severe presentation in a pregnant women?

A

hepatitis E

can cause DIC and fulminant liver failure in a pregnant women

115
Q

describe the CSF results in a patient with viral meningitis?

(glucose, protein, lymphocytes or neutrophils)

A

lymp§hocytosis

raised protein

normal glucose

116
Q

compare the CSF in TB and enteroviruses causing meningitis?

A

TB- cloudy, low glucose and elevated opening pressure

enteroviruses- clear, normal glucose, normal opening pressure

117
Q

what is the single most important stem in the Mx of necrotising fasciitis?

A

surgical referral

the only way to treat nec fasc is surgical debridement and IV antibiotics

118
Q

compare the penile ulceration seen in herpes and syphilis?

A

herpes: HSV-2, painful ulceration
syphilis: treponema pallidum, painless ulceration

119
Q

how are both chlamydia and gonorrhoea investigated?

A

NAAT testing of 1st pass urine sample

120
Q

which causative of pneumonia can also be responsible for causing co-existing guilian barre syndrome?

A

mycoplasma pneumonia

121
Q

which type of pneumonia can cause desaturation on exercise?

A

legionella pneumonia

122
Q

where should swabs for chlamydia and gonorrhoea be taken from in women?

A

the vulvo vaginal area

123
Q

when does HIV seroversion occur?

A

3-12 weeks post infection

symptoms are caused by the body’s production of HIV antibodies

symptoms include rash and sore throat

124
Q

what is the gold standard diagnosis for symptomatic schistomiasis?

A

stool and urine microscopy

125
Q

compare which conditions RSV and parainfluenza virus cause?

A

RSV: bronchiolitis

parainfluenza: croup

126
Q

how should primary genital herpes be managed during a pregancy?

A

oral acyclovir until delivery and delivery by CS

127
Q

how should genital warts be treated if there is a) multiple and b) solitary lesions?

A

a) multiple: topical podophyllum
b) solitary: cryotherapy

HPV types 6 and 11 are responsible for 90% of genital warts cases

128
Q

what is the most appropriate management of someone who has been told by a sexual partner that they have got chlamydia?

A

“treat then test”

offer antibiotic therapy before the result of the test is back

129
Q

name the 3 things involved in a disseminated gonococcal infection triad?

A

tenosynovitis

migratory poly arthritis

dermatitis

cutaneous lesions are usually small purpuric macules on the palms and soles which may develop into pustules

130
Q

name the 3 organisms those who have had a splenectomy are particularly at risk of?

A

H.Influenza

mengicoccus

pneumococcus

AA Y4 Finals cards NE (40 decks)

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