Infectious Diseases

Question 1

Glandula fever aka

Answer 1

Infectious mononucleosis

Question 2

What organism causes infectious mononucleosis?

Answer 2

EBV aka HHV-4 (human herpesvirus 4)

Question 3

What is the classic triad of infectious mononucleosis?

Answer 3

1. Sore throat
2. Fever
3. Lymphadenopathy

Question 4

What are the significant complications of infectious mononucleosis?

Answer 4

Splenomegaly- occurs in around 50% of patients and may rarely predispose to splenic rupture.
Hepatitis

Question 5

How is glandula fever diagnosed?

Answer 5

Heterophil antibody test (Monospot test)- NICE guidelines suggest FBC and Monospot in the 2nd week of the illness to confirm a diagnosis of glandular fever.

Question 6

Treatment for glandula fever:

Answer 6

Supportive Mangement:

• rest during the early stages, drink plenty of fluid, avoid alcohol
• simple analgesia for any aches or pains
• consensus guidance in the UK is to avoid playing contact sports for 4 weeks after having glandular fever to reduce the risk of splenic rupture

Question 7

What types of HPV are associated with developing cervical cancer?

Answer 7

HPV 16 & 18

Question 8

HPV 6 and 11 are associated with what?

Answer 8

HPV 6 and 11 are non-carcinogenic and associated with genital warts and laryngeal warts which can obstruct the airway.

Question 9

How do endocervical cells infected with HPV change?

Answer 9

Develop into ‘koliocytes’
- enlarged nucleus
- irregular nuclear membrane contour
- the nucleus stains darker than normal (hyperchromasia)
- a perinuclear halo may be seen

Question 10

Investigation for measles:

Answer 10

• 1st: measles specific IgM and IgG serology (ELISA) is most sensitive 3-14 days after onset of the rash
• 2nd: measles RNA detection by PCR best for swabs taken 1-3 days after rash onset

Question 11

What chemoprophylaxis is given for meningococcal meningitis?

Answer 11

Ciprofloxacin

Question 12

Most common complication following meningitis?

Answer 12

Sensorineural hearing loss

Question 13

Retro-orbital headache, fever, facial flushing, rash, THROMBOCYTOPENIA in returning traveller → ?

Answer 13

Dengue Fever

Rash = maculopapular blanching erythema over the body which spares the palms and soles.

Question 14

Treatment for meningitis <3months

Answer 14

IV CEFOTAXIME!! + IV Amoxicillin

Meningitis in children < 3 months: give IV amoxicillin in addition to cefotaxime to cover for Listeria.

Question 15

Surface antigen(HBsAg)

Answer 15

active infection

Question 16

E antigen(HBeAg)

Answer 16

marker of viral replication and implies high infectivity

Question 17

Core antibodies(HBcAb)

Answer 17

implies past or current infection

Question 18

Surface antibody(HBsAb)

Answer 18

implies vaccination or past or current infection

Question 19

Hepatitis B virus DNA(HBV DNA)

Answer 19

this is a direct count of the viral load

Question 20

Screening for hep b
- read well

Answer 20

When screening for hepatitis B, test HBcAb (for previous infection) and HBsAg (for active infection). If these are positive do further testing forHBeAg and viral load(HBV DNA).

Question 21

How can HBcAb be interpreted?

Answer 21

HBcAb can help distinguish between acute, chronic and past infection. We can measure IgM and IgG versions of the HBcAb. IgM implies an active infection and will give a high titre with an acute infection and a low titre with a chronic infection. IgG indicates a past infection where the HBsAg is negative.

Question 22

Commonest type of malaria

Answer 22

Falciparum malaria is the commonest type of malaria

Question 23

Flu like illness → brief remission→ followed by jaundice and haematemesis

Answer 23

Yellow fever