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Infectious Diseases Flashcards

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1
Q

What are the typical incubation periods for the main causes of gastroenteritis?

A

1-6 hrs: Staphylococcus aureus, Bacillus cereus
12-48 hrs: Salmonella, Escherichia coli
48-72 hrs: Shigella, Campylobacter
> 7 days: Giardiasis, Amoebiasis

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2
Q

Mycoplasma pneumoniae is a cause of atypical pneumonia which often affects younger patients.

Describe:
1. key features
2. complications
3. investigation
4. tx

A

Features:
prolonged and gradual onset
flu-like symptoms classically precede a dry cough
bilateral consolidation on x-ray

Complications:
- haemolytic anaemia, thrombocytopenia
- erythema multiforme, erythema nodosum
- meningoencephalitis, Guillain-Barre syndrome and other immune-mediated neurological diseases
- bullous myringitis: painful vesicles on the tympanic membrane

Investigation: serology - positive cold agglutination test

Tx: doxycycline or a macrolide (e.g. erythromycin/clarithromycin)

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3
Q

Describe the key features of amoebic dysentry. How is it treated?

A

profuse, bloody diarrhoea
there may be a long incubation period
stool microscopy may show trophozoites if examined within 15 minutes or kept warm (known as a ‘hot stool’)

treatment is with metronidazole

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4
Q

Describe the key features of an amoebic liver abscess

A

usually a single mass in the right lobe (may be multiple). The contents are often described as ‘anchovy sauce’

features: fever, RUQ pain

serology is positive in > 90%

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5
Q

A history of IV drug use coupled with a descending paralysis, diplopia and bulbar palsy is characteristic of infection with…

A

Clostridium botulinum
- gram positive anaerobic bacillus

typically seen in canned foods and honey
prevents acetylcholine (ACh) release leading to flaccid paralysis

Tx is early antitoxin

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6
Q

How is cellulitis diagnosed? How is it classified?

A

The diagnosis of cellulitis is clinical. No further investigations are required in primary care. Bloods and blood cultures may be requested if the patient is admitted and septicaemia is suspected.

Eron classification

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7
Q

Describe C. perfringens infection

A

produces α-toxin, a lecithinase, which causes gas gangrene (myonecrosis) and haemolysis

features include tender, oedematous skin with haemorrhagic blebs and bullae. Crepitus may present on palpation

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8
Q

Describe C. tetani infection

A

produces an exotoxin (tetanospasmin) that prevents the release of glycine from Renshaw cells in the spinal cord causing a spastic paralysis

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9
Q

Diphtheria is caused by the Gram positive bacterium Corynebacterium diphtheriae.
How does it present? How is it treated?

A

Possible presentations:
- recent visitors to Eastern Europe/Russia/Asia
- sore throat with a ‘diphtheric membrane’ - grey, pseudomembrane on the posterior pharyngeal wall
- bulky cervical lymphadenopathy (‘bull neck’ appearanace)
- neuritis e.g. cranial nerves
- heart block

Management:
-intramuscular penicillin
-diphtheria antitoxin

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10
Q

Typhoid and paratyphoid are caused by Salmonella typhi and Salmonella paratyphi (types A, B & C) respectively.

What are the key features of the infection?

A
  • relative bradycardia
  • abdominal pain, distension
  • constipation: although Salmonella is a recognised cause of diarrhoea, constipation is more common in typhoid
  • rose spots: present on the trunk in 40% of patients, and are more common in paratyphoid
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11
Q

What is Hairy leukoplakia?

A

an EBV-associated lesion on the side of the tongue, and is considered indicative of HIV

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12
Q

Spot diagnosis:

Common amongst travellers
Watery stools
Abdominal cramps and nausea

A

E. coli

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13
Q

Spot diagnosis:
Ongoing non-bloody diarrhoea, lethargy, bloating, flatulence, steatorrhoea +/- recent travel

A

Giardiasis

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14
Q

Spot diagnosis:

Profuse, watery diarrhoea (‘rice water’)
Severe dehydration resulting in weight loss
Not common amongst travellers

A

Cholera

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15
Q

Spot diagnosis:

Bloody diarrhoea
Vomiting and abdominal pain
Fever

A

Shigella

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16
Q

Spot diagnosis:

A flu-like prodrome followed by crampy abdominal pains, fever and diarrhoea which may be bloody
May mimic appendicitis
Complications include Guillain-Barre syndrome

A

Campylobacter

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17
Q

Spot diagnosis:

Two types of illness are seen
vomiting within 6 hours, stereotypically due to rice
diarrhoeal illness occurring after 6 hours

A

Bacillus cereus

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18
Q

Spot diagnosis:

Gradual onset bloody diarrhoea, abdominal pain and tenderness which may last for several weeks

A

Amoebiasis

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19
Q

Gonorrhoea is caused by the Gram-negative diplococcus Neisseria gonorrhoae.

How does it present differently in men and women?
What local complications can arise?

A

males: urethral discharge, dysuria
females: cervicitis e.g. leading to vaginal discharge

Local complications that may develop include urethral strictures, epididymitis and salpingitis

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20
Q

What is the major systemic complication of gonorrhea? How does it present?

A

Disseminated gonococcal infection (DGI)

Initially there may be a classic triad of symptoms: tenosynovitis, migratory polyarthritis and dermatitis.

Later complications include septic arthritis, endocarditis and perihepatitis (Fitz-Hugh-Curtis syndrome)

It is the most common cause of septic arthritis in young adults

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21
Q

How is gonorrhea treated?

A

The first-line treatment is a single dose of IM ceftriaxone 1g
(But if the organism is sensitive to ciprofloxacin then oral ciprofloxacin 500mg should be given)

if ceftriaxone is refused (e.g. needle-phobic) then oral cefixime 400mg + oral azithromycin 2g should be used

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22
Q

How does Pneumocystis jiroveci pneumonia present?
How is it treated?
Who should be given prophylaxis against it?

A

Common presentation: new-onset, dry cough, dyspnoea and desaturation on mobilisation on a background of AIDS
CXR often clear

treated with co-trimoxazole, which is a mix of trimethoprim and sulfamethoxazole

All patients with a CD4 count lower than 200/mm3 should receive prophylaxis against PJP

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23
Q

How should genital herpes in pregnancy be managed?

A

Elective C-section at term is advised if a primary attack of herpes occurs at greater than 28 weeks gestation (3rd trimester)
Oral aciclovir 400 mg TDS (three times daily) should be taken until delivery

Women with recurrent herpes who are pregnant should be treated with suppressive therapy and be advised that the risk of transmission to their baby is low

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24
Q

How does infectious mononucleosis (glandular fever) present?
How is it diagnosed?
How is it managed?

A

Classic triad:
1. sore throat
2. lymphadenopathy: may be present in the anterior and posterior triangles of the neck, in contrast to tonsillitis which typically only results in the upper anterior cervical chain being enlarged
3. pyrexia

Diagnosis:
FBC and Monospot test (heterophil antibody test) in the 2nd week of the illness to confirm diagnosis of glandular fever

Management is supportive
Contact sports should be avoided for 4 weeks
avoid alcohol

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25
Leptospirosis is caused by the spirochaete Leptospira interrogans, classically being spread by contact with infected rat urine. Who is at risk? How does it present? Tx?
sewage workers, farmers, vets, returning travellers the early phase is due to bacteraemia and lasts around a week (often mild): - fever and flu-like symptoms - subconjunctival suffusion (redness)/haemorrhage second immune phase may lead to more severe disease:(Weil's disease) - acute kidney injury (seen in 50% of patients) - hepatitis: jaundice, hepatomegaly - aseptic meningitis Tx is high-dose benzylpenicillin
26
Cause of necrotising fasciitis? How is it treated?
type 1 (most common) is caused by mixed anaerobes and aerobes (often occurs post-surgery in diabetics). type 2 is caused by Strep. pyogenes urgent surgical referral debridement intravenous antibiotics
27
What type of pneumonia does influenza predispose to?
Staph aureus pneumonia
28
Schistosomiasis, or bilharzia, is a parasitic flatworm infection. How does it present? Investigation? Tx?
- 'Swimmer's itch' - urinary frequency and haematuria - bladder calcification - eosinophilia Investigation: - for asymptomatic patients serum schistosome antibodies are generally preferred - for symptomatic patients the gold standard for diagnosis is urine or stool microscopy looking for eggs Tx: single oral dose of praziquantel
29
The risk of overwhelming post splenectomy infection (OPSI) is greatest in the first two years following splenectomy. Which organisms commonly cause it? What abx prophylaxis should be given?
Streptococcus pneumoniae Haemophilus influenzae Meningococci Penicillin V Pneumococcal vaccination is also offered Ideally 2 weeks before surgery
30
What are the complications of a splenectomy?
Haemorrhage (may be early and either from short gastrics or splenic hilar vessels) Pancreatic fistula (from iatrogenic damage to pancreatic tail) Thrombocytosis: prophylactic aspirin to mitigate Encapsulated bacteria infection e.g. Strep. pneumoniae, Haemophilus influenzae and Neisseria meningitidis
30
What blood film changes are seen post-splenectomy?
Platelets will rise first (therefore in ITP should be given after splenic artery clamped) Blood film will change over following weeks, Howell-Jolly bodies will appear Other blood film changes include target cells and Pappenheimer bodies
31
What is the diagnostic criteria for staphylococcal toxic shock (TSS)? How is it treated?
fever: temperature > 38.9ºC hypotension: systolic < 90 mmHg diffuse erythematous rash (w/ desquamation of rash, especially of the palms and soles) involvement of three or more organ systems: e.g. GI (D+V), mucous membrane erythema, renal failure, hepatitis, thrombocytopenia, CNS involvement (e.g. confusion) Tx: removal of infection focus (e.g. retained tampon) IV fluids + abx
32
How is asymptomatic bacteriuria in pregnancy managed?
Immediate tx with abx
33
Define septic shock
a subset of sepsis with profound circulatory, cellular and metabolic abnormalities, associated with greater risk of mortality than sepsis alone
34
Give some causes of fever in a returned traveller
0-10 days: Dengue, rickettsia, viral (including infectious mononucleosis), gastrointestinal (bacteria / amoeba) 10-21 days: Malaria, typhoid, primary HIV infection >21 days: Malaria, chronic bacterial infections (e.g. brucella, coxiella, endocarditis, bone and joint infections); TB; parasitic infections (helminths/protozoa)
35
Falciparum malaria is the commonest, and most severe, type of malaria. Describe the key presenting features
Feature of severe malaria: schizonts on a blood film parasitaemia > 2% hypoglycaemia acidosis temperature > 39 °C severe anaemia
36
What are the major complications of severe falciparum malaria?
hypoglycaemia cerebral malaria: seizures, coma acute renal failure: blackwater fever, secondary to intravascular haemolysis, mechanism unknown acute respiratory distress syndrome (ARDS) disseminated intravascular coagulation (DIC) shock may indicate coexistent bacterial septicaemia - malaria rarely causes haemodynamic collapse
37
First line tx for uncomplicated falciparum malaria?
WHO guidelines recommend artemisinin-based combination therapies (ACTs) as first-line therapy examples include artemether plus lumefantrine, artesunate plus amodiaquine, artesunate plus mefloquine
38
First line tx for complicated falciparum malaria?
a parasite counts of more than 2% will usually need parenteral treatment irrespective of clinical state - IV artesunate or Iv quinine dihydrochloride if parasite count > 10% then exchange transfusion should be considered
39
What is the most common cause of non-falciparum malaria?
Plasmodium vivax
40
How does non-falciparum malaria present?
general features of malaria: fever, headache, myalgia, anaemia, hepatosplenomegaly, jaundice Plasmodium vivax/ovale: cyclical fever every 48 hours. Plasmodium malariae: cyclical fever every 72 hours Plasmodium malariae: is associated with nephrotic syndrome. Ovale and vivax malaria have a hypnozoite stage and may therefore relapse following treatment.
41
How should non-falciparum malaria be treated?
in areas which are known to be chloroquine-sensitive then WHO recommend either an artemisinin-based combination therapy (ACT) or chloroquine in areas which are known to be chloroquine-resistant an ACT should be used ACTs should be avoided in pregnant women patients with ovale or vivax malaria should be given primaquine following acute treatment with chloroquine to destroy liver hypnozoites and prevent relapse
42
How is a diagnosis of malaria made?
malaria blood film - sent in an EDTA bottle (red) Need 3 samples over 3 consective days to exclude malaria due to 48 hour lifecyle can also do: FBC, U&Es, LFTs, glucose, coagulation CT head
43
What anti-malarials can be offered to travellers?
Proguanil and atovaquone (malarone) - 2 days before, daily and 1 week after mefloquine - once weekly 2 weeks before, during and 4 weeks after - can cause psychosis Doxycycline
44
The lungs remain the most common site for secondary tuberculosis. Where may extra-pulmonary infection affect?
central nervous system (tuberculous meningitis - the most serious complication) vertebral bodies (Pott's disease) cervical lymph nodes (scrofuloderma) renal gastrointestinal tract
45
How is TB investigated?
The Mantoux test is the main technique used to screen for latent tuberculosis. (interferon-gamma blood test may be used if risk of false negatives) Chest x-ray upper lobe cavitation is the classical finding of reactivated TB bilateral hilar lymphadenopathy Sputum smear 3 specimens are needed, rapid and inexpensive stained for the presence of acid-fast bacilli (Ziehl-Neelsen stain) all mycobacteria will stain positive (i.e. nontuberculous mycobacteria) Nucleic acid amplification tests (NAAT) allows rapid diagnosis (within 24-48 hours) more sensitive than smear but less sensitive than culture Sputum culture the GOLD STANDARD investigation more sensitive than a sputum smear and nucleic acid amplification tests can assess drug sensitivities can take 1-3 weeks
46
How is active TB managed?
Initial phase - first 2 months (RIPE) Rifampicin Isoniazid Pyrazinamide Ethambutol Continuation phase - next 4 months Rifampicin Isoniazid
47
How is latent TB managed?
latent tuberculosis is 3 months of isoniazid (with pyridoxine) and rifampicin OR 6 months of isoniazid (with pyridoxine)
48
Adverse effects of TB drugs?
rifampicin: potent liver enzyme inducer hepatitis, orange secretions flu-like symptoms isoniazid: liver enzyme inhibitor peripheral neuropathy: prevent with pyridoxine (Vitamin B6) hepatitis, agranulocytosis pyrazinamide: hyperuricaemia causing gout arthralgia, myalgia hepatitis ethambutol: optic neuritis: check visual acuity before and during treatment
49
Give some risks for reactivation of TB
HIV IV drug use TNF-alpha therapy solid organ transplantation and immunosuppression
50
Presentation of TB?
Gradually worsening symptoms Lethargy Pyrexia and night sweats Weight loss Cough +/- haemoptysis Lymphadenopathy Erythema nodosum
51
HIV seroconversion occurs about 3-12 weeks after initial infection. How does it present if symptomatic?
Like glandular fever sore throat lymphadenopathy malaise, myalgia, arthralgia diarrhoea maculopapular rash and mouth ulcers rarely meningoencephalitis antibodies to HIV may not be present HIV PCR and p24 antigen tests can confirm diagnosis
52
When should asymptomatic patients be screened for HIV?
4 weeks following potential exposure
53
What is the first line for HIV testing?
combination tests (HIV p24 antigen and HIV antibody) are now standard for the diagnosis and screening of HIV - if the combined test is positive it should be repeated to confirm the diagnosis
54
Name some key AIDS defining illnesses
Kaposi's sarcoma (caused by human herpes virus 8) PCP CMV Candidiasis (oesophageal or bronchial) Lymphoma TB
55
How can HIV be monitored?
CD4 count ( 500-1200 is normal, under 200 is end stage /AIDS) Viral Load
56
How should HIV be managed?
Antiretroviral therapy (ART) involves a combination of at least 3 drugs, typically 2 nucleoside reverse transcriptase inhibitors (NRTI) and either a protease inhibitor (PI) or a non-nucleoside reverse transcriptase inhibitor (NNRTI). This combination both decreases viral replication but also reduces the risk of viral resistance emerging patients should start ART as soon as they have been diagnosed, rather than waiting until a particular CD4 count NRTI: zidovudine (AZT), abacavir, emtricitabine, didanosine, lamivudine, stavudine, zalcitabine, tenofovir PI: indinavir, nelfinavir, ritonavir, saquinavir NNRTI: nevirapine, efavirenz
57
Pneumonia with lymphopenia, hyponatraemia & deranged LFTs → ? How do you definitively diagnose this?
Legionella Atypical pneumonia, classically spread by air-conditioning systems Urinary antigen test
58
What is a chancre?
Painless indurated lesion characteristic of the primary stage of syphilis
59
flu-like symptoms, RUQ pain, tender hepatomegaly and deranged LFTs → ?
Hepatitis A It is usually associated with contaminated food or water in countries where it is endemic. It is also associated with MSM and IV drug users in the UK.
60
An effective vaccination is available for Hep A - who should be offered it?
aged > 1 year old and travelling to high prevalence area chronic liver disease haemophilia MSM IVDU individuals at occupational risk: laboratory worker; staff of large residential institutions; sewage workers; people who work with primates
61
Most common complication of gonorrhoea?
Infertility secondary to PID
62
Most common cause of PID?
Chlamydia (gonorrhoea second)
63
Tx of cellulitis?
Flucloxacillin If penicillin allergic clarithromycin, doxycycline or erythromycin (in pregnancy) is recommended Co-amoxiclav if severe
64
worsening flu-like symptoms and a dry cough, with erythema multiforme noted on examination suggests...
mycoplasma pneumonia
65
Common causes of genital ulcers?
painful: herpes much more common than chancroid painless: syphilis more common than lymphogranuloma venereum
66
Most common cause of central line infections?
staph epidermidis
67
Most likely cause of a small calcified nodule in the lungs in someone who has spent time in an area with high levels of TB?
A calcified Ghon complex - latent TB
68
What investigation should you always do in a patient with hx of persistent PUO, lymphadenopathy, and weight loss with high WCC ?
lymph node biopsy - look for lymphoma
69
Most common cause of genital warts (90%)?
HPV 6 & 11
70
Associated condition for respiratory syncytial virus?
Bronchiolitis
71
Associated condition for parainfluenza virus?
Croup
72
Associated condition for Haemophilus influenzae?
Community-acquired pneumonia Most common cause of bronchiectasis exacerbations Acute epiglottitis
73
Most common cause of CAP?
Streptococcus pneumoniae
74
What is BV?
Bacterial vaginosis (BV) is an overgrowth of predominately anaerobic organisms e.g. Gardnerella vaginalis which = a fall in aerobic lactobacilli that produce lactic acid→ raised vaginal pH Fishy/offensive discharge or can be asymptomatic
75
Man returns from trip abroad with maculopapular rash and flu-like illness→
think HIV seroconversion
76
What is red man syndrome?
adverse reaction associated with rapid intravenous infusion vancomycin - not the same as anaphylaxis redness, pruritus and a burning sensation, predominantly in the upper body (face, neck and upper chest) due to vancomycin-related activation of mast cells with release of histamine infusion should be stopped and restarted at a slower rate
77
Retro-orbital headache, fever, facial flushing, rash, thrombocytopenia in returning traveller →
think dengue fever investigate with bloods (leukopenia, thrombocytopenia, raised aminotransferases) , serology and NS1 antigen test management is supportive
78
Why is doxycycline contraindicated in pregnancy?
risk of permanent dental discolouration and enamel hypoplasia in the developing fetus.
79
Tx for pubic lice (Phthirus pubis)?
malathion lotion or permethrin cream (insecticides) Both should be applied to the whole body and washed off after 12 hours repeat after a week
80
Chlamydia is the most prevalent STI in the UK and is caused by Chlamydia trachomatis. How does it present in men and women? Investigation? Tx?
women: cervicitis (discharge, bleeding), dysuria men: urethral discharge, dysuria often ASYMPTOMATIC Investigation: for women: the vulvovaginal swab is first-line for men: the urine test is first-line Chlamydia testing should be carried out two weeks after a possible exposure Tx: doxycycline (7 day course) if pregnant then azithromycin, erythromycin or amoxicillin may be used (azithromycin 1g stat preferable)
81
Supportive management of genital herpes?
saline bathing analgesia topical anaesthetic agents e.g. lidocaine
82
Farmer, fever, transaminitis ? How do you confirm diagnosis and treat?
Q fever - caused by Coxiella burnetti (lives within cattle and sheep) Presents with fevers, headaches, fatigue and muscle aches Chronic Q-fever can present with endocarditis. Diagnosis = serological testing Tx = doxycycline
83
What is the Jarisch-Herxheimer reaction?
adverse reaction sometimes seen following treatment of syphilis due to release of endotoxins presents w fever, rash and tachycardia, but no wheeze and no hypotension no tx needed except maybe paracetamol to bring down fever
84
What PEP should be given post hep B and hep C exposure?
Hep B known responder to vaccine : booster vaccine non-repsonder to vaccine : hepatitis B immune globulin (HBIG) and booster Hep C monthly PCR - if seroconversion then interferon +/- ribavirin
85
What PEP should be given post HIV exposure?
low-risk incidents such as human bites don't require post-exposure prophylaxis high-risk incidents like needle stick injuries should be treated with a combo of oral antiretrovirals (e.g. Tenofovir, lopinavir and ritonavir) ASAP for 4 weeks with serological testing at 12 weeks following completion
86
Lyme disease is caused by the spirochaete Borrelia burgdorferi and is spread by ticks. How does it present? Investigations? Tx?
Presentation: Erythema migrans - painless bullseye rash Systemic features e.g. lethargy, fatigue, arthralgia Late features- heart block, pericarditis, facial nerve palsy, radicular pain Investigations: Can be diagnosed clinically if rash present otherwise serology - ELISA antibodies to Borrelia burgdorferi are the first-line test Tx: doxycycline or ceftriaxone in disseminated disease
87
Fever, abdominal pain, constipation, 'rose' spots →
think typhoid fever!
88
Fever, facial spasms, dysphagia in an intravenous drug user →
think tetanus
89
Where should swabs for chlamydia and gonorrhoea in women be taken from?
the vulvo-vaginal area (introitus)
90
Fever, loin pain, nausea and vomiting → Management?
acute pyelonephritis obtain a MSU sample and then start on cefalexin for 14 days ( or IV ceftriaxone in hospital)
91
Tx for human and animal bites?
co-amoxiclav
92
Appropriate next step after needlestick injury?
Bleed and wash the wound Ask a colleague to complete a risk assessment and take the patient's blood as they will be able to be objective Inform occupational health
93
HIV, neuro symptoms, multiple brain lesions with ring enhancement on CT→ Management?
Toxoplasmosis- accounts for half of cerebral lesions in patients with HIV management: sulfadiazine and pyrimethamine
94
Hep B with acute flare up→ Hep B with deterioration / decompensated liver disease→
Hepatitis D superinfection Hepatocellular carcinoma
95
Most viral or bacterial gastroenteritis do not require treatment. How should invasive diarrhoea (causing bloody diarrhoea and fever) be treated?
ciprofloxacin
96
What is the most effective single step to reduce the incidence of MRSA?
Hand hygiene
97
What is Trichomonas vaginalis? Presentation? Tx?
STI caused by flagellated protozoan parasite vaginal discharge: offensive, yellow/green, frothy strawberry cervix pH > 4.5 in men is usually asymptomatic but may cause urethritis tx: metronidazole for 5-7 days
98
HIV + proctitis ?
Lymphogranuloma venereum
99
Which pneumonia is associated with reactivation of herpes and cold sores?
Pneumonia caused by Streptococcus pneumoniae
100
Which antibiotic can cause a disulfiram like reaction if taken with alcohol?
Metronidazole
101
Which are the live attenuated vaccines?
BCG MMR yellow fever oral typhoid oral polio
102
Campylobacter infection is often self-limiting but if severe then what tx can be given?
clarithromycin
103
most common non-immune cause of foetal hydrops in pregnancy? what is the immune cause?
Parvovirus B19 (Immune is Rh disease)
104
Painless genital pustule → ulcer → painful inguinal lymphadenopathy → proctocolitis =
lymphogranuloma venereum - caused by three serovars of Chlamydia trachomatis
105
When should reinfection with syphilis be suspected?
if the RPR rises by 4-fold or more
106
Perform stool microscopy for a child if ...
1) You suspect septicaemia 2) there is blood and/or mucus in the stool or 3) the child is immunocompromised
107
URTI symptoms + amoxicillin → rash?
glandular fever
108
commonest cause of viral encephalitis in the adult population?
herpes simplex
109
Causes of acute pancreatitis?
I GET SMASHED I – Idiopathic G – Gallstones E – Ethanol T – Trauma S – Steroids M – Mumps, malignancy (Pancreatic cancer) A – Autoimmune S – Scorpion sting H – Hypercalcemia, Hypertriglyceridemia E – ERCP D – Drugs
110
Approach to asymptomatic bacteria in catheterised patients?
Do not treat
111
List 4 possible complications of gastroenteritis
Lactose intolerance Irritable bowel syndrome Reactive arthritis Guillain–Barré syndrome
112
What are the two special tests you can perform to look for meningeal irritation?
Kernig’s test involves lying the patient on their back, flexing one hip and knee to 90 degrees and then slowly straightening the knee whilst keeping the hip flexed at 90 degrees. This creates a slight stretch in the meninges and where there is meningitis will produce spinal pain or resistance to this movement. Brudzinski’s test involves lying the patient flat on their back and gently using your hands to lift their head and neck off the bed and flex their chin to their chest. A positive test is when this causes the patient to involuntarily flex their hips and knees.
113
Compare CSF findings for bacterial V viral meningitis : appearance, protein, glucose, WCC and culture.
Bacterial V Viral Appearance Cloudy V Clear Protein High V Mildly raised or normal Glucose Low V Normal White Cell Count High (neutrophils) V High (lymphocytes) Culture Bacteria V Negative
114
Urethritis in a male, negative for Gonorrhoea and Chlamydia →
?Mycoplasma genitalium
115
Tx of bacterial meningitis?
3 months - 50 years: cefotaxime (or ceftriaxone) > 50 years: cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin) for adults
116
The India ink stain on cerebrospinal fluid (CSF) analysis points towards which causative organism of meningitis?
Cryptococcus neoformans - fungal cause

Y3 Medicine (9 decks)

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