Infectious Diseases Flashcards
Most common isolated organism for animal bites
Pasteurella multocida
Mx animal bite + human
Non medical
Abx (1)
Pen allergic abx (2)
Clean wound
Abx - co-amox or if pen allergic then doxy and metro
Abx for:
Exacerbation of chronic bronchitis
CAP (+ pen allergic)
CAP if staph suspected i.e in which condition?
Atypical pneumonia
HAP <5/7 >5/7
Bronchicitis Amoxi or doxy or clarithro
CAP Amoxi (Doxy or clarithro)
If staph Add fluclox i.e in influenza
Atypical Clarithro
Within 5/7 of admission coamox or cefuroxime
>5/7 taz or ceftazidime or cipro
Abx
Pyelo (2)
Prostatitis (2)
Cephalosporin or cipro
Cipro or trimethoprim
Impetigo abx
Top (1)
PO (2)
Top hydrogen peroxide
PO fluclox or erythro if widespread
Erysipelas abx (1)
Pen allergic (3)
Fluclox
Clarithro/ erythro/ doxy if pen allergic
Cellulitis if pen allergic (3)
Clarithro/ erythro/ doxy
Cellulitis near eyes or nose
Abx (1)
Pen allergic (2)
Coamox
Clarithro + metro
Gingivitis acute necrotising ulcerative abx
Metro
Sinusitus
Phenoxymethylpenicillin
Otitis media pen allergic
Externa
Erythro
Fluclox
Gonorrhoea (1)
Chlamydia (2)
IM ceftriaxone
Doxy/azithro
PID (2) OR (3)
Oflox + metro OR
IM ceftriaxone + doxy + metro
Syphillis mx
(1) OR (1) OR (1)
Benzathine benpen OR
Doxy OR
Erythro
BV mx (1) or (1)
Treatment length range
PO or topical metro
OR
topical clinda
5-7 days
C diff mx
First episode
Second or subsequent episode
PO vanc
PO fidaxomicin
Abx mx
Campylo (1)
Salmonella (1)
Shigellosis (1)
Clarithro
Cipro
Cipro
BV bacterium
pH
Description
Microscopy
Amsell’s criteria
Gardnerella vaginalis
Raised pH >4.5
Fishy offensive smell
Clue cells
3 out of 4 criteria should be present, clue cells, +ve Whiff’s test, thin, white discharge, pH >4.5
Who is offered the BCG? (7)
All infants 0-12 months:
1. in areas where incidence is >40/100,000
2. parent or grandparent born in a country where incidence is >40/100,000 (and older children >6yo need a tuberculin test first)
3a unvaccinated tuberculin negative contacts of TB
3b unvaccinated, tuberculin negative, new entrants <16yo who were born in or lived for >3 months) in a country with incidence > 40/100,000
4. HCP
5. Prison staff
6. Staff of care home of the elderly
7. People who work with the homeless
CI to BCG (5)
Age cut off
Prev BCG
Positive tuberculin test
HIV
Pregnancy
PMH TB
35yo
Bed bugs cause (1)
Mx (1)
Cimex hempteru
Topical hydrocort
Bed bugs cause (1)
Mx (1)
Cimex hempteru
Topical hydrocort
Middle East
Farmers, vets, abattoir workers
2 week incubation period
Fever, malaise, hepatosplenomegaly, sacroilitis, spinal tenderness, leukopenia
= which condition?
Dx screening and best test
Mx (2)
Brucellosis
Rose Bengal plate test
Brucella serology
Doxy or streptomycin
When to treat campylobacter?
Abx
OR
Complications (3)
Severe symptoms, fever, bloody diarrhoea, or >8stools per day OR sx >1 week
Clarithro OR cipro
Guillain Barre
Reactive arthritis
Sepsis, endocarditis, arthritis
Bartonella henselae
Gram +ve or negative
Disease name
Gram negative rod
Cat scratch disease
Eron classification of cellulitis (1-4)
I no systemic sx no co-morbidities
II systemic sx or not but with co-morbidities
III sig systemic sx
IV sepsis or severe/life threatening
Cellulitis common causes (2)
Strep pyog
Staph aur
Painful genital ulcers with unilateral painful inguinal lymph nodes
Sharply defined, ragged, undermined border (ulcers) = which condition
Chancroid
Mx chlamydia and length
(1) or (1)
Doxy (7/7) OR azithro 1g OD for 1/7 then 500mg OD for 2/7
Chlamydia:
For men with urethral symptoms which contacts should be contacted?
For women and asymptomatic men who should be contacted?
All contacts since and in the four weeks prior to the onset of sx
All partners from the last six months or most recent partner
Treat then test
Gram +ve rods (5)
Gram negative cocci (2)
Gram +ve cocci (2)
Actinomyces
Bacillus anthracis
Clostridium
Diphtheria
Listeria
Neisseria + morzella catarrhalis
Staph and strep
Remaining organisms are gram negative rods
HIV and young children with watery diarrhoea =
Dx
Mx
Cryptosporidiosis
Ziehl Neelsen stain - characteristic red cysts
Mx supportive or nitazoxanide or rifaximin
intensely itchy, ‘creeping’ serpiginous rash = which condition?
Mx (2)
Cutaneous larva migrans
Mx albendazole or ivermectin
Recent visitors to Eastern Europe/ Russia/ Asia
sore throat
grey, pseudomembrane on the posterior pharyngeal wall
Bulky cervical lymphadenopathy
Bull neck appearancce
Neuritis
Heart block =
Mx (2)
Diphtheria
Mx IM penicillin or diphtheria antitoxin
Strawberry cervix, vulvovaginitis, pH >4.5, green discharge =
Microscopy
Mx
TV
Motile trophozites
PO metro 5-7 days
HSV 1
HSV 2
Sx (2)
1 = cold sore
2 = genital
Multiple painful ulcers
Primary attacks severe with fever, subsequent less severe
Painless ulcer (chancre) =
Syphillis primary stage
Small painless pustule –> ulcer –> painful inguinal lymphadenopathy –> proctocolitis =
Mx
Lymphogranuloma venerum
Mx doxy
Parapox virus
Animals: Scabby lesions around the mouth and nose
Humans: Hands and arms affected
Small, raised, red blue papules initially then flat topped and haemorrhagic and increase in size = which condition?
Orf
Systemic upset
Relative bradycardia
Constipation
Faecal oral route spread
Gram negative rods
Contaminated food and water =
Compliactions (4)
Typhoid
GI bleed
Osteomyelitis
Meningitis
Cholecystitis
EBV associated conditions (3)
Lymphomas
Nasopharyngeal carcinoma
Hairy leukoplakia
Most common cause of traveller’s diarrhoea
E coli
Food poisoning most common bacteria (3)
Staph aureus
Bacillus cereus
Clostridium perfringens
Bloody diarrhoea (3)
Shigella
Campylobacter
Amoebiasis
Prolonged non bloody diarrhoea
Giardiasis
Short incubation period and severe vomiting =
Staph aureus
Flu like prodrome followed by AP, fever, diarrhoea, bloody
May mimic which condition?
Complication (1)
Campylobacter
Appendicitis
Guillian Barre
Gradual onset bloody diarrhoea + AP which may last for weeks
Amoebiasis
Incubation period
1-6 hours (2)
12-48 hours (2)
48-72 hours (2)
> 7 days (2)
Bacillus, Staph Aur
E coli, Salmonella
Shigella, Campylo
Amoebiasis, Giardiasis
Genital warts caused by which HPV?
Mx
1st line (2)
2nd line (1)
6&11
Topical podophyllum or cryo
Imiquimod topical
Swimming/ drinking water from a river/ lake
Foreign travel
Faeco-oral route
Male to male sexual contact =
Mx
Giardiasis
Metronidazole
Hep A,B,C,D,E
RNA or DNA
Spread of transmission
Which one is self limiting, doesn’t cause HCC
All but B is RNA
Hep B = double stranded DNA
A+E faecal oral route
B&D bodily fluids
Hep A (self limiting)
Gonorrhoea mx (1)
IM ceftriaxone 1g
Most common cause of septic arthritis in young adults
Gonococcal
Classic triad features of disseminated gonococcal infection (3)
Tenosynovitis
Migratory polyarthritis
Dermatitis
When and who is anti-HBs tested?
Interpretation
>100
10-100
<10
Those at risk of occupational exposure
1-4 months after primary immunisation
> 100 adequate response, should receive booster at 5 years
10-100 suboptimal response, one additional vaccine
<10 x3 doses vaccine course as non responder
Which hepatitis requires another hep surface antigen to complete its replication and transmission cycle
Hep D requires hep B
Which hepatitis requires another hep surface antigen to complete its replication and transmission cycle
Hep D requires hep B
Herpes simplex mx
Gingivostomatitis (2)
Cold sores (1)
Genital herpes (1)
Mode of delivery
Aciclovir + chlorhexidine mouthwash
Topical aciclovir
PO aciclovir
ELCS if primary attack occurs >K28
Features herpes simplex (3)
Cold sores
Painful genital ulcers
Severe gingivostomatitis
Most common cause of infective diarrhoea in pts with HIV
Microscopy
Crytptosporidium
Red cysts on Ziehl Neelsen
Most common cause of infective diarrhoea in pts with HIV
Microscopy
Crytptosporidium
Red cysts on Ziehl Neelsen
What is Kaposi’s sarcoma caused by?
HHV-8 (human herpes virus 8)
What is Kaposi’s sarcoma caused by?
HHV-8 (human herpes virus 8)
presents as purple papules or plaques on the skin or mucosa (e.g. gastrointestinal and respiratory tract)
skin lesions may later ulcerate
respiratory involvement may cause massive haemoptysis and pleural effusion
=
Kaposi’s sarcoma
HIV mx
SE of NRTI
Start as soon as diagnosis has been made with x2 NRTI + PI/NNRTI
peripheral neuropathy
Multiple ring or nodular enhancing lesions, SPECT negative =
Mx (2)
Toxoplasmosis
Sulfadiazine/ pyrimethamine
Single or multiple homogenous enhancing lesions, SPECT +ve =
Associated with which virus?
Mx
CNS lymphoma
EBV
Steroids
Most common fungal infection of CNS in HIV pt
CSF High opening pressure, India ink test positive
Focal neurological deficit
Cryptococcus
symptoms, subacute onset : behavioural changes, speech, motor, visual impairment
CT: single or multiple lesions, no mass effect, don’t usually enhance. MRI is better - high-signal demyelinating white matter lesions are seen
Progressive multifocal leukoencephalopathy (PML)
When should testing for HIV occur in an asymptomatic pt?
4 weeks after possible exposure then again at 12 weeks
HPV vaccination is offered to (2)
12 and 13 year old girls and boys (2 doses)
Men who have sex with men <45yo
Triad of sx for EBV/ glandular fever
Why should they avoid playing contact sports?
Sore throat, pyrexia, lymphadenopathy
Risk of splenic rupture
Influenza vaccine children
Route
Age
Type of vaccine
Who needs two doses?
How effective in adults?
Intranasal
2-3yo
Live vaccine
Children aged 2-9 who have not received an influenza vaccine before
75% effective
Air conditioning bacteria =
Other features (6)
Dx
Mx
Legionella
Dry cough
Relative bradycardia
Hyponaetraemia
Derranged LFTs
Pleural effusions
Lymphopenia
Urinary antigen
Erythro/ clarithro
Haemolytic anaemia
ITP
Erythema multiforme
Myocarditis
= which bacteria causing pneumonia
Mycoplasma
Sand flies
Crusted liesion at the site of bite
Underlying ulcer
Can spread to nose, pharynx =
Leishmaniasis
Infected rat urine, sewage workers, farmers, vets, returning traveller =
Mx (2)
Leptospirosis
Benpen or doxy
Spread by ticks = which condition
Typical rash
First line investigation
Mx (2)
If desseminated
Lyme disease
Bulls eye rash (erythema migrans)
ELISA antibodies
Mx doxy/ amoxi
Ceftriaxone
Most common cause of non falciparum malaria (and location) =
Next most common and location
Vivax = Central America
Ovale = Africa
Features of vivax/ovale versus malariae
Malariae is associated with ?
Cyclical fever every 48 hours versus 72 hours
Nephrotic syndrome
Antimalarial of choice in pregnancy
Chloroquine
Which anti-malarial can cause neuropsychiatric disturbance?
GI upset
CI in epilepsy
Oesophagitis/ photosensitivity
Mefloquine
Malarone
Chloroquine
Doxy
Mx meningitis in GP
In hospital
If <3 months or >50yo add in
If caused by listeria give
Meningococcal meningitis
If pen allergic
IM benpen
IV cefotaxime
Amoxi
IV amoxi
IV benpen or cefotaxime
Chloramphenicol
Prophylaxis of meningitis to close contacts =
Cipro
Metronidazole does what to warfarin?
Avoid with
Increases anticoagulant effect
ETOH
Live attenuated vaccines (7)
BCG
MMR
Influenza (intranasal)
PO rotavirus
PO polio
Yellow fever
PO typhoid
When to send a urine culture?
> 65yo
Visible or non visible haematuria
Nitro and trimethorpim in pregnancy
Nitro avoid near term
Trimethoprim avoid in first trimester (and throughout pregnancy)
Active TB Mx
Rifampacin
Isoniazid
Pyrazinamide
Ethambutal
(2 months)
then R + I for a further 4 months
Latent TB Mx
3 months of R + I
OR
6 months I
SE x1 each
Rifampacin
Ison
Pyraz
Etham
R: orange secretions
I: peripheral neuropathy, agranulocytosis
P: gout
E: optic neuritis
Disease spread by the tsetse fly
Features (3)
Mx
= sleeping sickness (African trypanosomiasis)
Painless subcutaneous nodule at site of infection
Intermittent fever
Enlargement of posterior cervical lymph nodes
Mx IV pentamidine or suramin
What is Chagas disease?
Affects which which organs?
Mx
American tryponasomiasis
Heart and GI tract
Benznidazole
Adverse effects of tetracyclines (4)
Discoloration of teeth (<12 years)
Photosensitivity
Angioedema
Black hairy tongue
Tetanus vaccination
Patient has had a full course of tetanus vacc (x5) with the last dose <10 years =
Patient has had a full course of tetanus vaccines, with the last dose > 10 years ago
If tetanus prone wound:
High risk wounds:
If vaccination history is incomplete or unknown
All wounds
Tetanus prone and high risk
No vaccine, IG is needed
Vaccine
Vaccine + IG
Vaccine
Tetanus prone and high risk vaccine + IG
Syphillis features
Primary (2)
Secondary (3)
Tertiary (3)
Chancre - painless ulcer
Local non tender lymphadenopathy
Systmic sx
Rash on trunk, palms and soles
Snail track ulcers (buccal)
Warty lesions on the genitalaia
Tertiary
Paralysis of the insane
Argyll Robertson
Granulomatous lesions (gummas)
Congenital syphillis symptoms(4)
Hutchinson’s teeth
Rhagades
Saddle nose
Deafness
SE of cotrimoxazole =
High K
SI of cotrimoxazole =
High K
diarrhoea
abdominal pain/bloating
papulovesicular lesions where the skin has been penetrated by infective larvae e.g. soles of feet and buttocks
larva currens: pruritic, linear, urticarial rash
if the larvae migrate to the lungs a pneumonitis similar to Loeffler’s syndrome may be triggered
=
Mx
strongyloides
Mx ivermectin and albendazole
MRSA suppression =
Nose: mupirocin 2% in white soft paraffin TDS 5/7
Skin: chlorhexidine OD 5/7
MRSA suppression =
Nose: mupirocin 2% in white soft paraffin TDS 5/7
Skin: chlorhexidine OD 5/7
Complications of mumps (3)
Orchitis
Hearing loss
Pancreatitis
Features of mycoplasma pneumonia
(3)
Dx (2)
Mx
Prolonged and gradual onset
Dry cough
Bilateral consolidation on CXR
serology
positive cold agglutination test
Mx doxy or erythro or clarithro
Gram negative diploccoci
Purulent urethral discharge =
Gonococcal
Unpasteurized eggs or milk + bloody diarrhoea =
Salmonella
Rose red rash (slapped cheek syndrome)
Does not involve palms or soles
Warm bath, sunlight, heat or fever will trigger recurrence of the rash
=
School?
Parvovirus B19
Can still go to school
CAP most common bacteria
COPD
After influenza infection
ETOH
Atypical
Strep pneum
H. influe
Staph A
Klebsiella
Mycoplasma
rapid onset
high fever
pleuritic chest pain
herpes labialis (cold sores)
=
Strep pneum
prodrome: headache, fever, agitation
hydrophobia: water-provoking muscle spasms
hypersalivation
Negri bodies: cytoplasmic inclusion bodies found in infected neurons
=
Rabies
How do you manage a dog bite in at risk countries (3)
Clean wound
If immunised then give x2 further doses of vacc
If not then Human rabies IG + full course of vacc locally around the wound
Name the pathogen
Bronchiolitis
Croup
Common cold
Flu
Common cause of pneumonia in HIV pts
RSV
Parainfluenza
Rhinovirus
Influenza
Jiroveci
What is caused by togavirus?
Rubella
prodrome, e.g. low-grade fever
rash: maculopapular, initially on the face before spreading to the whole body, usually fades by the 3-5 day
lymphadenopathy: suboccipital and postauricular
=
Rubella
Swimmers itch + eosinophillia, cough, diarrhoea =
Schisto = parasitic worm
Acute
frequency
haematuria
bladder calcification
swimmers itch
Mx
= chronic schisto
Mx PO praziquantel
Vaccinations needed with splenectomy
Abx prophylaxis
Hib, men A&C
Annual influenza
5 yearly pneumococcal
Penicillin V
