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RACP 2023 > INFECTIOUS DISEASES > Flashcards

INFECTIOUS DISEASES Flashcards

1
Q

Treatment for proctitis?

A

Cef
Doxy
Valciclovir

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2
Q

HPV vaccinations are for types:

A

16 and 18

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3
Q

HPV is associated with which cancers?

A

Oropharyngeal
Anal = 90%
Cervical = almost ALL
Penile
Vaginal = 60%
Vulval
Genital warts = ALL

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4
Q

Which antiviral is used to treat HSV in pregnancy?

A

Aciclovir

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5
Q

Treatment of resistant HSV?

A

Fosacarnet

Often TK mutation

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6
Q

Treatment of syphilis according to stages

A

Primary/secondary/early latent (symptomatic/asymptomatic < 2 years)
- Stat IM dose

Late latent (asymptomatic > 2 years)
- Stat weekly dose for 3 weeks

Tertiary (symptomatic > 2 years)
- IV benzene Q4H 15 days

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7
Q

Syphilis testing; what would you expect to see in a:

1) currently infected
2) treated
3) early infection

A

1)
TPPA (+)
RPR/VRDL (high titre)

2)
TPPA (+)
RPR/VRDL (-)

3)
TPPA (+)
RPR/VRDL (low titre)

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8
Q

What does this test mean
RPR/VRDL (low titre)
TPPA (-)

A

False (+)
Early infection

Repeat in 2-4 weeks

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9
Q

M genitalum treatment and why?

A

Doxy then azithro
- poor efficacy against M genitalum, high azithro resistance

Repeat test in 1 month to confirm eradication

Persisting: moxiflox

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10
Q

PID treatment

A

Cef
Doxy
Metro

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11
Q

Treatment for gonorrhea

A

Cef + azithro

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12
Q

Treatment for chlamydia

A

Azithro/doxy

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13
Q

Contract tracking are required for which diseases?

A

Chlamydia
Gonorrhea

HIV
Syphilis

Hepatitis A,B

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14
Q

How does ESCAPPM mediate resistance?

A

amp C gene –> produces beta lactamase/ cephalosporinase

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15
Q

ESBL treatment?

A

Carbapenems
Ceftazidime avibactam
Linezolid
PO: trimeth sulfa

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16
Q

ESCAPPM organisms

A

Enterbacter
Serratia
Citrobacter
Acinebacter
Pseudomonas
Proteus vulgaris
Morganella Morganii

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17
Q

MRSA causes resistance through? Treatment?

A

meCA gene –> altered PBP
Poor affinity for penicillins, cephalosporins, more carbapenems

Tx
Vanc
daptomycin: inactivated by surfactant
Teicoplanin
Ceftaroline

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18
Q

VRE mechanism and treatment?

A

Altered PBP

Tx: Dapto, Linezolid

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19
Q

CRO mechanism and treatment?

A

Hydrolyses beta lactam ring

Tx: Colistin, amikacin, dual carbapenems

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20
Q

How to diagnose most zoonoses?

A

Serology
PCR if bite/eschar

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21
Q

Treatment for cat scratch disease?

A

Nothing - supportive

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22
Q

When would you suspect typhus/ flea or tick disease?

A

Eschar
Spotted fever

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23
Q

Key features of typhoid?
- transmission
- key clinical features
- treatment

A

faecal oral (water)

constipation, bradycardia

rose spots, GI bleeding, abdomen pain, fever

cef + azithro

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24
Q

Which types of malaria are most pathogenic?

A

falciparum
knowlesi

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25
Q

Which type of malaria is drug resistant?

A

falciparum

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26
Q

Which malaria type persists in liver?

A

Vivax
Ovale

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27
Q

What do you need to treat in malaria viva and ovale?

A

Hyponozite –> lays quiescent in liver

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28
Q

What drug do you add to treat vivax/ovale? What do you need to check first?

A

Primaquine

Check G6PD

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29
Q

Malaria prophylaxis

A

Atovaquone/proguanil
Doxy

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30
Q

Which form of entamoeba is treated with metro?

A

Trophozites

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31
Q

Treatment for entamoeba?

A

Metro

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32
Q

Treatment for dengue?

A

Supportive

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33
Q

Stages of dengue

A

Saddleback fever
Breakbone fever
Dehydration
Shock, bleeding, organ impairment
Fluid overload: ascites, pl effusion

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34
Q

How to diagnose dengue early and late in disease?

A

BEFORE 5 DAYS
- PCR/ serum: virus
- ELISA test: NS1 antibody

DAY 4-5
- Serology: IgM D3-5 –> later on IgG by first week
- Life long IgG
- Cross reactivity with other flaviviruses for serology

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35
Q

Clinical features of monkeypox?

A

Skin lesions
Fever, lymphadenopathy
Recent outbreak; MSM –> genital lesions

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36
Q

Treatment of monkeypox

A

Antivirals:Tpoxx, Tecavirimat
Vaccination

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37
Q

What cell receptors on HIV and T cell binds to allow for cell invasion?

A

GP120 on HIV –> CCR5 (early disease) CXCR4 (late disease)

GP41 coils and allows cells to bind

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37
Q

What cell receptors on HIV and T cell binds to allow for cell invasion?

A

GP120 on HIV –> CCR5 (early disease) CXCR4 (late disease)

GP41 coils and allows cells to bind

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38
Q

What infections occur in HIV when T cells < 0.05

A

MAC
CMV
lymphoma
PML

39
Q

What infections occur in HIV T cells > 0.2

A

Karposi
Candidiasis
PJP

40
Q

What infections occur in HIV T cells = 0.1

A

cerebral toxoplasmosis
cryptococcal meningitis

41
Q

What agents are use for prophylaxis during HIV, and for which disease?

A

bactrim –> PJP, toxoplasmosis

42
Q

What agent is added to bactrim for HIV prophylaxis when CD4 <50

A

MAC prophylaxis: azithro/doxy/ rifampcin/ rifabutin

43
Q

Biggest killer in HIV?

A

Cancer
AIDS

44
Q

Highest risk of exposure for HIV transmission?

A

Anal sex

45
Q

What does spike protein in COVID bind to in human cells?

A

ACE2/TMPRSS2 receptor found in URT, gut

46
Q

What do monoclonal antibodies/vaccines target in COVID?

A

spike protein

47
Q

Paxclovid components and mechanism?

A

Nirtmatrelevir: protease
Ritonavir: boost by inhibiting CYP450

48
Q

Remdesivir and Molnupirivir MoA?

A

Inhibits RNA polymerase and replication

49
Q

Baracitinib MoA?

A

TKI JAK1+2

50
Q

Tozlizumab MoA?

A

IL-6 monoclonal antibody

51
Q

Evusheld MoA?

A

Anti-spike antibodies

52
Q

Pfizer + Novovax vaccine mechanism + type

A

mRNA

Gives the instruction to T cell to make spike –> displays on cell

53
Q

AZ vaccine mechanism and type?

A

viral vector

Goes into cell and release virus into cytoplasm –> mRNA transcribed –> spike proteins displayed on cell

54
Q

Moderna vaccine mechanism and type?

A

Protein subunit

Most immunogenic part of virus

55
Q

How does alcohol gel kill organisms?

A

Lipid bi layer

56
Q

Fever returned traveller: what to suspect incubation period < 10 days

A

dengue
ricketssial
malaria

57
Q

Fever returned traveller: what to suspect incubation period 10-21 days

A

malaria
hepatitis
brucellosis
typhoid

58
Q

Fever returned traveller: what to suspect incubation period > 21 days

A

liver abscess
hepatitis
leishmaniasis

59
Q

When NOT to use prophylaxis for IE?

A

MVP
Septal defects
Implantable electronic devices

60
Q

When to use prophylaxis for IE?

A

Prev IE

Prosthetic lateral

CHD: unrepaired dynamic defects

61
Q

MoA beta lactase?

A

Binding to PBP –> prevent peptidoglycan crosslinking

62
Q

Which carbapenem does not cover pseudomonas?

A

Ertapenem

63
Q

Newer generations of cephalosporins have better gram ___ cover

A

Negative

64
Q

Which Abx lowers seizure threshold?

A

Carapenems

65
Q

Which Abx class interacts with tac?

A

Macrolides

66
Q

Se’s of ciprofloxacin?

A

Tendon rupture
Prolonged QT
AAA rupture

67
Q

Which anti fungal has CNS and urine penetration?

A

Fluconazole

68
Q

Which anti fungals have CNS penetration?

A

Amphotericin
Fluconazole

69
Q

MoA Echinocandins, amphtericin, azoles

A

Azoles: inhibits ergosterol synthesis in cell wall
Amphotericin: inhibits ergosterol in cell membrane –> pore formation
Echinocandins (fungins): inhibits B12D gluten synthase in cell wall

70
Q

Pseudomonas bactaeremia treatment

A

Ceftazidime
Tazocin

71
Q

Ischemic hepatitis: LFT picture?

A

ALT + AST > 1000 or 50xULN
Elevated LDH
Evidence of end organ hypoperfusion

72
Q

Chronic LD/ NALF LFTs picture?

A

ALT:AST > 1

73
Q

Come drug-induced causes of liver failure?

A

Statins
Fluclox
CMZ
Anti-epileptics
Chemo
PCT
NSAIDs

74
Q

Viral hepatitis LFT picture?

A

ALT+AST > 25x ULN

75
Q

Ischemic hepatitis LFT picture?

A

ALT+AST > 50xULN

76
Q

Acute liver failure LFT picture?

A

ALT+AST > 10x ULN
Prolonged PT
HE

77
Q

Wilson’s LFT picture?

A

AST > ALT
Bili: ALP raised
low uric acid

78
Q

Causes of Massive elevations in aminotransferases (>5,000 U/L)?

A

Drugs
Ischemic

79
Q

Causes of AST/ ALT > 1

A

Alcohol
Cirrhosis: viral hepatitis, NAFLD
Wilsons

80
Q

K cells (Small intestine) produces?

A

Gastric Inhibitory Peptide Hormones
- Decreased gastric acid
Increases insulin

81
Q

D cells produce?

A

Somatostatin
- Decr gastric acid
- Inhibits GB contraction
- Inhibits pancreatic secretion
- Inhibits growth hormone
- Vasocontriction

82
Q

S cells (Small intestine) produce?

A

Secretin
Increases pancreatic HCO3, bile secretion –> neutralises stomach acid

83
Q

I cells (small intestine) produce?

A

CCK
- Stimulated pancreatic secretion, gallbladder contraction
- Relaxes sphincter of oddi
- Pyloric sphincter contracts –> prevents reflux of contents

84
Q

VIP does what in the GI system?

A
  • Pancreatic HCO3 secretion
    • Inhibits H+
    • Promoted sphincter relaxation
      • Stimulates chloride secretion in small intestine and small intestine contractility –> diarrhea
85
Q

Pancreatic polypeptide effect?

A

Inhibits pancreatic section

86
Q

Motilin effect?

A

Increases gastric emptying

87
Q

Peptide YY does what?

A

Slow gastric emptying and increases digestion efficiency

88
Q

Most common cause of eosinophilic meningitis?

A

Angiostrongylus cantonensis most common parasitic cause
§ Raw/undercooked snails
§ SEA
Raw produce containing small snail/slug

89
Q

Aedes Aegypti is the vector for which diseases?

A

Yellow fever
Dengue
Zika
Chikungunya

90
Q

Abx assoc with C diff?

A

Fluoroquinolones
Clinda
Cef 2nd 3rd
Amp/amoxi

91
Q

What pathology does C diff cause?

A

Pseudomembranous colitis

92
Q

Most common organism in
- adults > 60
- adults < 60

A

Strep for both

93
Q

Second most common organism in
- adults > 60
- adults < 60

A

N meningitidis
Listeria

94
Q

Most common cause of parasitic meningitis?

A

Angiostrongylus cantonensis

RACP 2023 (17 decks)

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