infectious diseases Flashcards
needlestick injury whilst taking blood from a patient who is known to be HIV positive
mx?
oral antiretroviral therapy for 4 weeks
58-year-old farmer
high fever, sweating profusely
several black blisters which produce foul smelling discharge.
bug?
dx: Gas gangrene
clostridium perfringens
rash is most often seen in early Lyme disease?
Erythema chronicum migrans (‘bulls-eye’)
seen in?
Rheumatic fever
UTI in pregnancy
tx?
Campylobacter jejuni.
tx? when to tx?
complications?
Campylobacter infection is often self-limiting but if severe then treatment with clarithromycin may be indicated
if more then 8 bowel movements needs abx
Guillain-Barre syndrome may follow Campylobacter jejuni infections
reactive arthritis
septicaemia, endocarditis, arthritis
Human bite abx
CO-AMOXICLAV
Bacterial vaginosis in pregnancy
Bacterial vaginosis: oral metronidazole 400mg 5 days
What is the most effective method for limiting the spread of norovirus?
wash hands with soap and water
34-year-old man presents with a widespread maculopapular rash and mouth ulcers.
Two months ago he reports developing a painless penile ulcer.
bug?
secondary syphilis
Treponema pallidum
MSRA tx?
Nasal mupirocin + chlorhexidine for the skin
involved in a fight
rusty knife
has all the tetnas jabs
tetanus risk?
If a patient has had 5 doses of tetanus vaccine, with the last dose < 10 years ago, they don’t require a booster vaccine nor immunoglobulins, regardless of how severe the wound is
which abx plus alcohol can cause a disulfiram-like reaction (flushing)
metronidazole
Cefoperazone, a cephalosporin,
DnV after meal within 30 mins to 8 hours, bug?
Staphylococcus aureus gastroenteritis is characterised by a short incubation period and severe vomiting
bug with clue cells?
Kaposi’s sarcoma - caused by
HHV-8 (human herpes virus 8)
pregnant woman is found to have tested positive syphilis, tx?
IM benzathine penicillin G
flu vaccine in children
administration route?
first dose?
vaccine live or dead?
non-productive cough, dullness to percussion on the right upper lobe,, previous TB. X-ray is taken which shows a target-shaped lesion in the right upper lobe with air crescent sign present.
dx?
An aspergilloma may arise in a lung cavity that developed secondary to previous tuberculosis
immigrant 12-year-old boy advised to get BCG for TB. what do you do?
it is important that a tuberculin skin test is performed (to exclude past exposure to tuberculosis) prior to giving the vaccine.
pregnant women more likely to get listeria?
pregnant women are almost 20 times more likely to develop listeriosis compared with the rest of the population due to changes in the immune system
make up of bug causing this?
Streptococcus pyogenes, a beta-haemolytic group A streptococci
purulent discharge, Gram-negative diplococci.
bug? tx?
intramuscular ceftriaxone (ALONE) is the treatment of choice for Gonorrhoea
purulent discharge, Gram-negative diplococci.
bug? tx?
intramuscular ceftriaxone (ALONE) is the treatment of choice for Gonorrhoea
most commonly diagnosed sexually transmitted infection in the UK?
chlamydia
Stereotypical features of ….?……. include flu-like symptoms and a dry cough, relative bradycardia and confusion. Blood tests may show hyponatraemia
Legionella
Stereotypical features of ….?……. include flu-like symptoms and a dry cough, relative bradycardia and confusion. Blood tests may show hyponatraemia
Legionella
Animal bites tx for wound after abx?
Thorough washout and dressing only
which TB meds cause urine to go bright colour?
Rifampicin can cause orange tears/urine
tx for chlamydia? if preggo?
Chlamydia - treat with doxycycline
if pregnant then azithromycin, erythromycin or amoxicillin may be used
What is the most effective single step to reduce the incidence of MRSA?
HAND HYGIENE
multiple painful ulcers on the shaft of his penis.
herpes simplex
rose spots on her abdomen.
Salmonella typhi
34-year-old man is diagnosed as being HIV positive. what point should anti-retroviral therapy be started?
Anti-retroviral therapy for HIV is now started at the time of diagnosis, rather than waiting for the CD4 count to drop to a particular level
39-year-old man
SOB flu like symptoms
non-productive cough
chest x-ray shows bilateral consolidation and examination reveals erythematous lesions on his limbs and trunk.
dx?
lu-like symptoms, bilateral consolidation and erythema multiforme point to a diagnosis of Mycoplasma. The most appropriate diagnostic test is Mycoplasma serology
virus that is capable of producing pancytopenia in patients with a predisposing haematological disease?
Parvovirus B19
Erythema infectiosum (also known as fifth disease or ‘slapped-cheek syndrome’)
19 yo boy in thailand, has a rabies vaccine, gets bitten by dog
tx?
if an individual is already immunised then 2 further doses of vaccine should be given plus possible abx
if not previously immunised then human rabies immunoglobulin (HRIG) should be given along with a full course of vaccination. If possible, the dose should be administered locally around the wound
Pneumocystis jiroveci penumonia is treated with
co-trimoxazole, which is a mix of trimethoprim and sulfamethoxazole
following antibiotics should be avoided in the first trimester of pregnancy to tx uti?
trimethoprim
URTI symptoms + amoxicillin → rash
dx?
A rash develops in around 99% of patients who take amoxicillin whilst they have infectious mononucleosis.
painful deep ulcer with a ragged border is seen on the shaft of the penis.
Chancroid causes painful genital ulcers
side note: Herpes simplex is another sexually transmitted cause of painful genital ulceration however usually presents as multiple, superficial, vesicular lesions. Additionally, inguinal lymphadenopathy is more classical of chancroid rather than herpes simplex.
50 yo with flu symptoms- the nhas a chest cough. what bug?
Preceding influenza predisposes to Staphylococcus aureus pneumonia
live attenuated vaccines
bacterial vaginosis
bug make up?
Gram-positive and negative bacteria
Atypical pneumonia tx?
Clarithromycin
Should be added in the treatment of pneumonia if secondary to influenza
Flucloxacillin
appropriate investigation to test for Lyme disease?
ELISA
suspected prostatitis should immediately be started on antibiotic therapy. tx?
cipro
genitourinary medicine clinic due to four fleshy, protuberant lesions on her vulva which are slightly pigmented.
dx and tx?
Malaria: prophylaxis
avoided if the patient has a history of epilepsy
Chloroquine
Can be stopped just one week after returning from a malarial zone
Atovaquone + proguanil
Malaria: prophylaxis
Is taken weekly
Chloroquine
inactivated preparation of influenza?
intramuscular
Mycoplasma is associated with….?…type of rash
erythema multiforme
bloating, watery diarrhoea, floating stools. returned from pakistan 4 days ago
Giardia lamblia
Malabsorption can be caused by chronic Giardia infection
21-year-old man
2 week history of burning when he urinates, worse in the morning
itching around his penis.
urine dip and find that it is leukocyte positive.
cause?
Urethritis due to a sexually transmitted infection
urethritis in young men is most commonly due to a sexually transmitted infection (STI).
active TB tx?
man had sex with a girl who has now tested positive for chlamydia. how do you mx him?
Offer Chlamydia testing and antibiotic treatment immediately without waiting for the results
46%
deep-ish cut with garden tool- not aware if tetnus jab given
mx?
Patients with an uncertain tetanus vaccination history should be given a booster vaccine + immunoglobulin, unless the wound is very minor and < 6 hours old
First line treatment for early Lyme disease is
a 14-21 day course of oral doxycycline
44-year-old farmer
headache, fever and muscle aches
Subconjunctival haemorrhages
dx?
Leptospirosis
…..?….. doses of the tetanus vaccine are given over the course of the routine immunisation schedule
5
gastro diarrhea bugs
which has the longest vs shortest incubation period?
longest: Giardiasis
shortest: bacillus cereus
primary genital herpes
What is the most appropriate management?
oral aciclovir
anti malarial:
associated with photosensitivity
avoided if the patient has a history of depression
doxy
MEFLOQUINE
UTI tx length of time in man vs woman?
woman- nitro for 3 days
man- nitro for 7 days
diagnosis and screening of HIV
HIV p24 antigen and HIV antibody
Genital warts - 90% are caused by HPV …?….
6 & 11
dry cough and target rash present on both her lower limbs, chest x-ray shows reticulo-nodular shadowing of the right lung.
dx?
The dry cough, erythema multiforme (symmetrical target shaped rash with a central blister) and the radiological findings point to a diagnosis of Mycoplasma.
prodrome: 3 days of feeling generally unwell
now 1 day of bloody diarrhoea
went to a bbq
what bug?
Campylobacter infection is characterised by a prodrome, abdominal pain and bloody diarrhoea
needle stick injury, man has hep b, shes in the process of getting the vaccines what to do do avoid hep b?
Give an accelerated course of the hepatitis B vaccine + hepatitis B immune globulin
Mastitis during breast-feeding
abx?
Flucloxacillin
Dental abscess ax?
Amoxicillin
what abx interacts with methotrexate?
trimethoprim
who should get the BCG vaccine?
children born in areas where tuberculosis (TB) is prevalent, or if their parents or grandparents are from areas with a high rate of TB. It is also given to people who have a high risk of occupational exposure to TB -who are under the age of 35.
The BCG vaccine is not given to anyone over the age of 35, as there is no evidence that it works for people of this age group.
prophylaxis for contacts of patients with meningococcal meningitis i.e flat mate has it
oral cipro
complaining of severe pain in his perineum and scrotum
purple rash with bullae present covering the entire perineum and extending up the scrotum
BP 110/90mmHg, heart rate 109bpm, respiration rate 21/minute, temperature 38.1ºC, and oxygen saturation 98%
Necrotising fasciitis: most commonly affected site is the perineum
side note- t2dm increases risk
Pelvic inflammatory disease abx?
Doxycycline + metronidazole + ceftriaxone
MDC PID
Extensive otitis externa
FLUCLOX
TB drugs RIPE s/e?
rifampicin
isoniazid
pyrazinamide
ethambutol
Salmonella typhi
presentation?
What is the best treatment?
constipated more common- but can cause the runs, bloated, temperature, sparse macular rash- rose spots
ciprofloxacin
HIV positive presents with a 2 day history of diarrhoea. What is the most likely cause of his diarrhoea?
Cryptosporidium
Bacterial vaginosis - overgrowth of predominately?
Gardnerella vaginalis
painful eruption of spots around her vaginal area
dx?
Painful vesicles in the genital area are usually symptomatic of Herpes simplex infection.
A 14-month-old boy who has a barking cough which is worse at night.
dx ? bug? tx?
Parainfluenza virus croup
tx dexamethasone
HIV positive man with cough and dyspnoea. Auscultation of his chest is unremarkable but he is noted to desaturate on exertion.
Pneumocystis jiroveci
alternative to treat early Lyme disease if doxycycline is contraindicated such as in pregnancy?
Amoxicillin
latent TB tx?
Common cold bug?
Rhinovirus
45-year-old smoker who develops pneumonia
Mycoplasma pneumoniae
bug?
Streptococcus pneumoniae
6-month-old who is ‘chesty’, has rhinitis and is off her feeds. Auscultation of her chest reveals bibasal crackles and an expiratory wheeze.
RSV
Infective exacerbation of COPD ABX?
Amoxicillin or tetracycline or clarithromycin
Acute pyelonephritis ABX?
Broad-spectrum cephalosporin or quinolone
38 wk preggo and uti mx?
cefalexin or amoxicillin
When should a test of cure (TOC) be performedcin pregnnat women? when treating sti clamydia?
6 weeks
healthy person with toxoplasmosis
tx?
Immunocompetent patients with toxoplasmosis don’t usually require treatment
viruses is associated with nasopharyngeal carcinoma?
EPV
SEX WORKER
neck stiffness and and mild photophobia and as such a lumbar puncture is performed.
lumbar puncture show a yeast and a capsule in the CSF stained with India ink.
Cryptococcus neoformans meningitis
painful genital and oral ulceration.
Behcet’s disease
The classic triad in Behcet’s is oral ulcers, genital ulcers and uveitis. Venous thromboembolism is also seen.
addition of what meds (not abx) improves outcomes (by reducing neurological sequelae) in the treatment of bacterial meningitis
dexamethasone
