INFECTIOUS DISEASES Flashcards by Jananee Myooran

Treatment for proctitis?

Cef
Doxy
Valciclovir

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HPV vaccinations are for types:

16 and 18

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HPV is associated with which cancers?

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

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Which antiviral is used to treat HSV in pregnancy?

Aciclovir

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Treatment of resistant HSV?

Fosacarnet

Often TK mutation

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Treatment of syphilis according to stages

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

1) currently infected
2) treated
3) early infection

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

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

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

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

False (+)
Early infection

Repeat in 2-4 weeks

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M genitalum treatment and why?

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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PID treatment

Cef
Doxy
Metro

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Treatment for gonorrhea

Cef + azithro

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Treatment for chlamydia

Azithro/doxy

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Contract tracking are required for which diseases?

Chlamydia
Gonorrhea

HIV
Syphilis

Hepatitis A,B

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How does ESCAPPM mediate resistance?

amp C gene –> produces beta lactamase/ cephalosporinase

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ESBL treatment?

Carbapenems
Ceftazidime avibactam
Linezolid
PO: trimeth sulfa

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ESCAPPM organisms

Enterbacter
Serratia
Citrobacter
Acinebacter
Pseudomonas
Proteus vulgaris
Morganella Morganii

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MRSA causes resistance through? Treatment?

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

Tx
Vanc
daptomycin: inactivated by surfactant
Teicoplanin
Ceftaroline

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VRE mechanism and treatment?

Altered PBP

Tx: Dapto, Linezolid

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CRO mechanism and treatment?

Hydrolyses beta lactam ring

Tx: Colistin, amikacin, dual carbapenems

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How to diagnose most zoonoses?

Serology
PCR if bite/eschar

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Treatment for cat scratch disease?

Nothing - supportive

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When would you suspect typhus/ flea or tick disease?

Eschar
Spotted fever

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

faecal oral (water)

constipation, bradycardia

rose spots, GI bleeding, abdomen pain, fever

cef + azithro

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Which types of malaria are most pathogenic?

falciparum
knowlesi

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Which type of malaria is drug resistant?

falciparum

Which malaria type persists in liver?

Vivax Ovale

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

Hyponozite --> lays quiescent in liver

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

Primaquine Check G6PD

Malaria prophylaxis

Atovaquone/proguanil Doxy

Which form of entamoeba is treated with metro?

Trophozites

Treatment for entamoeba?

Metro

Treatment for dengue?

Supportive

Stages of dengue

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

How to diagnose dengue early and late in disease?

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

Clinical features of monkeypox?

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

Treatment of monkeypox

Antivirals:Tpoxx, Tecavirimat Vaccination

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

GP120 on HIV --> CCR5 (early disease) CXCR4 (late disease) GP41 coils and allows cells to bind

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

GP120 on HIV --> CCR5 (early disease) CXCR4 (late disease) GP41 coils and allows cells to bind

What infections occur in HIV when T cells < 0.05

MAC CMV lymphoma PML

What infections occur in HIV T cells > 0.2

Karposi Candidiasis PJP

What infections occur in HIV T cells = 0.1

cerebral toxoplasmosis cryptococcal meningitis

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

bactrim --> PJP, toxoplasmosis

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

MAC prophylaxis: azithro/doxy/ rifampcin/ rifabutin

Biggest killer in HIV?

Cancer AIDS

Highest risk of exposure for HIV transmission?

Anal sex

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

ACE2/TMPRSS2 receptor found in URT, gut

What do monoclonal antibodies/vaccines target in COVID?

spike protein

Paxclovid components and mechanism?

Nirtmatrelevir: protease Ritonavir: boost by inhibiting CYP450

Remdesivir and Molnupirivir MoA?

Inhibits RNA polymerase and replication

Baracitinib MoA?

TKI JAK1+2

Tozlizumab MoA?

IL-6 monoclonal antibody

Evusheld MoA?

Anti-spike antibodies

Pfizer + Novovax vaccine mechanism + type

mRNA Gives the instruction to T cell to make spike --> displays on cell

AZ vaccine mechanism and type?

viral vector Goes into cell and release virus into cytoplasm --> mRNA transcribed --> spike proteins displayed on cell

Moderna vaccine mechanism and type?

Protein subunit Most immunogenic part of virus

How does alcohol gel kill organisms?

Lipid bi layer

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

dengue ricketssial malaria

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

malaria hepatitis brucellosis typhoid

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

liver abscess hepatitis leishmaniasis

When NOT to use prophylaxis for IE?

MVP Septal defects Implantable electronic devices

When to use prophylaxis for IE?

Prev IE Prosthetic lateral CHD: unrepaired dynamic defects

MoA beta lactase?

Binding to PBP --> prevent peptidoglycan crosslinking

Which carbapenem does not cover pseudomonas?

Ertapenem

Newer generations of cephalosporins have better gram ___ cover

Negative

Which Abx lowers seizure threshold?

Carapenems

Which Abx class interacts with tac?

Macrolides

Se's of ciprofloxacin?

Tendon rupture Prolonged QT AAA rupture

Which anti fungal has CNS and urine penetration?

Fluconazole

Which anti fungals have CNS penetration?

Amphotericin Fluconazole

MoA Echinocandins, amphtericin, azoles

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

Pseudomonas bactaeremia treatment

Ceftazidime Tazocin

Ischemic hepatitis: LFT picture?

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

Chronic LD/ NALF LFTs picture?

ALT:AST > 1

Come drug-induced causes of liver failure?

Statins Fluclox CMZ Anti-epileptics Chemo PCT NSAIDs

Viral hepatitis LFT picture?

ALT+AST > 25x ULN

Ischemic hepatitis LFT picture?

ALT+AST > 50xULN

Acute liver failure LFT picture?

ALT+AST > 10x ULN Prolonged PT HE

Wilson's LFT picture?

AST > ALT Bili: ALP raised low uric acid

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

Drugs Ischemic

Causes of AST/ ALT > 1

Alcohol Cirrhosis: viral hepatitis, NAFLD Wilsons

K cells (Small intestine) produces?

Gastric Inhibitory Peptide Hormones - Decreased gastric acid Increases insulin

D cells produce?

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

S cells (Small intestine) produce?

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

I cells (small intestine) produce?

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

VIP does what in the GI system?

- Pancreatic HCO3 secretion - Inhibits H+ - Promoted sphincter relaxation - Stimulates chloride secretion in small intestine and small intestine contractility --> diarrhea

Pancreatic polypeptide effect?

Inhibits pancreatic section

Motilin effect?

Increases gastric emptying

Peptide YY does what?

Slow gastric emptying and increases digestion efficiency

Most common cause of eosinophilic meningitis?

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

Aedes Aegypti is the vector for which diseases?

Yellow fever Dengue Zika Chikungunya

Abx assoc with C diff?

Fluoroquinolones Clinda Cef 2nd 3rd Amp/amoxi

What pathology does C diff cause?

Pseudomembranous colitis

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

Strep for both

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

N meningitidis Listeria

Most common cause of parasitic meningitis?

Angiostrongylus cantonensis