Infectious diseases Flashcards
How to manage red man syndrome with vancomycin?
Stop the vancomycin infusion until symptoms resolve and then re start at a slower rate
What is a rapid plasma reagin test?
useful to monitor disease activity and reinfection. It is written as the number of times a sample containing syphilis needs to be diluted before it becomes undetectable. Therefore, 1 in 2 means it needs to be diluted twice, whereas 1 in 32 means it needs to be diluted 32 times (meaning disease activity is higher in the latter). A rise by 4-fold or more in a previously infected patient either indicates no treatment response or reinfection.
What stains with india ink?
Cryptococcus neoformans
Management of cerebral toxoplasmosis?
pyrimethamine plus sulphadiazine for at least 6 weeks
Gram positive rods mneumonic
ABCD L
Actinomyces
Bacillus anthracis (anthrax)
Clostridium
Diphtheria: Corynebacterium diphtheriae
Listeria monocytogenes
Gram negative rods?
Escherichia coli
Haemophilus influenzae
Pseudomonas aeruginosa
Salmonella sp.
Shigella sp.
Campylobacter jejuni
Management of pneumocytitis jiroveci pneumonia?
co-trimoxazole
IV pentamidine in severe cases
aerosolized pentamidine is an alternative treatment for Pneumocystis jiroveci pneumonia but is less effective with a risk of pneumothorax
steroids if hypoxic (if pO2 < 9.3kPa then steroids reduce risk of respiratory failure by 50% and death by a third)
First line for syphilis?
intramuscular benzathine penicillin
What is the Jarisch-Herxheimer reaction
fever, rash, tachycardia after the first dose of antibiotic
Standard for diagnosis and screening of HIV?
combination tests (HIV p24 antigen and HIV antibody) are now standard for the diagnosis and screening of HIV
if the combined test is positive it should be repeated to confirm the diagnosis
some centres may also test the viral load (HIV RNA levels) if HIV is suspected at the same time
First line for gonorrhoea?
IM ceftriazone
Monitoring for terbinafine?
LFTs checked before commencing terbinafine and 4-6 weeks into treatment
What is trichomonas vaginalis?
highly motile, flagellated protozoan parasite. Trichomoniasis is a sexually transmitted infection (STI).
What is giardiasis?
flagellate protozoan Giardia lamblia. It is spread by the faeco-oral route.
Complications of mycoplasm pneumoniae?
cold agglutins (IgM): may cause an haemolytic anaemia, thrombocytopenia
erythema multiforme, erythema nodosum
meningoencephalitis, Guillain-Barre syndrome and other immune-mediated neurological diseases
bullous myringitis: painful vesicles on the tympanic membrane
pericarditis/myocarditis
gastrointestinal: hepatitis, pancreatitis
renal: acute glomerulonephritis
What is kaposi’s sarcoma caused by?
Human herpes virus 8
Live attenuated vaccines
BCG
MMR
oral polio
yellow fever
oral typhoid
Features of giardiasis?
often asymptomatic
non-bloody diarrhoea- steatorrhoea
bloating, abdominal pain
lethargy
flatulence
weight loss
malabsorption and lactose intolerance can occur
adverse effects of metronisazole?
disulfiram-like reaction with alcohol
increases the anticoagulant effect of warfarin
Progressive multifocal leukoencephalopathy (PML)
widespread demyelination
due to infection of oligodendrocytes by JC virus (a polyoma DNA virus)
What pneumonia cause is associated with cold sores?
Streptococcus pneumoniae
IV antibiotic in 3 months-50 YO with meningococcal meningitis?
cefotaxime (or ceftriaxone)
If over 50 first abx in meningococcal meningitis?
cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin) for adults
What is HIV seroconversion?
symptomatic in 60-80% of patients and typically presents as a glandular fever type illness. Increased symptomatic severity is associated with poorer long term prognosis. It typically occurs 3-12 weeks after infection
WHat does legionaella typically colonise?
typically colonizes water tanks and hence questions may hint at air-conditioning systems or foreign holidays
Legionella manaegement
Treat with erythromycin/clarithromycin
What is Q fever caused by?
Coxiella burnetii
Features of Q fever?
typically prodrome: fever, malaise
causes pyrexia of unknown origin
transaminitis
atypical pneumonia
endocarditis (culture-negative)
Management of Q fever?
Doxycyline
Features of enteric fever?
initially systemic upset as above
relative bradycardia
abdominal pain, distension
constipation: although Salmonella is a recognised cause of diarrhoea, constipation is more common in typhoid
rose spots: present on the trunk in 40% of patients, and are more common in paratyphoid
Features of herpes simplex virus?
primary infection: may present with a severe gingivostomatitis
cold sores
painful genital ulceration
Live attenuated vaccine mneumonic?
Mi Booty
MMR
Influenza (intranasal)
BCG
Oral polio
Oral rotavirus
Typhoid
Yellow Fever
Investigation of choice for chlamydia?
Nucleic acid amplification tests (NAATs)
TB management inital phase?
irst 2 months (RIPE)
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol (the 2006 NICE guidelines now recommend giving a ‘fourth drug’ such as ethambutol routinely - previously this was only added if drug-resistant tuberculosis was suspected)
What is gonorrhea caused by?
Gram-negative diplococcus Neisseria gonorrhoea
First line for management of meningitis contacts?
oral ciprofloxacin or rifampicin
What are clue cells seen in?
BV
Amstel’s criteria state that 3 out of 4 of the following should be present for a diagnosis of BV:
Thin, white, homogeneous discharge.
Vaginal fluid pH >4.5.
Clue cells on microscopy of wet mount.
Release of a fishy odour on adding alkali (potassium hydroxide).
Severe cellulitis treatment?
Only say the C word if its a SEVERE situation
Cellulitis Mx = Co-amox / Cefuroxime / Clindamycin / Ceftriaxone
Features of trichomonas vafinalis?
vaginal discharge: offensive, yellow/green, frothy
vulvovaginitis
strawberry cervix
pH > 4.5
in men is usually asymptomatic but may cause urethritis
Treartment of trichmonas vaginalis?
Oral metronidazole
First line for animal bites?
Co-amoxiclav
Typical presentation of bacillus cerus infection?
Two types of illness are seen
vomiting within 6 hours, stereotypically due to rice
diarrhoeal illness occurring after 6 hours
Diptheria presentation
recent visitors to Eastern Europe/Russia/Asia
sore throat with a ‘diphtheric membrane’ - grey, pseudomembrane on the posterior pharyngeal wall
bulky cervical lymphadenopathy
may result in a ‘bull neck’ appearanace
neuritis e.g. cranial nerves
heart block
First line for syphilis?
intramuscular benzathine penicillin is the first-line management
Are the herpes ulcers painful or painless?
Painful
What is leptospirosis caused by?
Leptospira interrogans
Pneumonia cause commonly after influenza infection
Staphylococcus aureus
Immunocompromised patients with toxoplasmosis are treated with what?
pyrimethamine plus sulphadiazine
What does clostridium perfringes produce?
produces α-toxin, a lecithinase, which causes gas gangrene (myonecrosis) and haemolysis
Causes of false-negative Mantoux test
immunosuppression (miliary TB, AIDS, steroid therapy)
sarcoidosis
lymphoma
extremes of age
fever
hypoalbuminaemia, anaemia
Gonorrhea treatment if dont want IM cefitraxone?
oral cefixime + oral azithromycin
Why should nitrofuratonin be avoided during breast feeding?
small amounts in milk but can cause haemolysis in G6PD infants.
patients with ovale or vivax malaria should be given what folowing acute treatment?
Primaquine
How does parvovirus B19 present in pregnant women?
parvovirus B19 in pregnant women can cross the placenta in pregnant women
this causes severe anaemia due to viral suppression of fetal erythropoiesis → heart failure secondary to severe anaemia → the accumulation of fluid in fetal serous cavities (e.g. ascites, pleural and pericardial effusions)
Incubation periods of different diarroheal illnessses
1-6 hrs: Staphylococcus aureus, Bacillus cereus*
12-48 hrs: Salmonella, Escherichia coli
48-72 hrs: Shigella, Campylobacter
> 7 days: Giardiasis, Amoebiasis
UTI towards end of pregnancy?
Amoxicillin or cefalexin
Management of suspected/confirmed lyme disease?
doxycycline if early disease. Amoxicillin is an alternative if doxycycline is contraindicated
Pneumocystis jiroveci penumonia is treated with what?
Co-trimaxazole
Adverse effects of tetracyclines?
discolouration of teeth: therefore should not be used in children < 12 years of age
photosensitivity
angioedema
black hairy tongue
What is chancroid?
tropical disease caused by Haemophilus ducreyi.
Chancroid makes du cry (painful ulcer, painful lymph node)
HSV 1 and 2 which ones is mouth and which is genital herpes?
1 is mouth and 2 is genital herpes
HSV1 and 2. You got one mouth and two baws.
HSV 1 and 2 which ones is mouth and which is genital herpes?
1 is mouth and 2 is genital herpes
HSV1 and 2. You got one mouth and two baws.
Medication for acute epiglottisi?
Haemophilus influenza type B
Bacterial causes of otitis externa?
Pseudomonas aeruginosa
Incubatio period for ebola?
2 to 21 days
What is the most common opportunistic infection in AIDS?
PCP
Investigation findings in PCP?
CXR: typically shows bilateral interstitial pulmonary infiltrates but can present with other x-ray findings e.g. lobar consolidation. May be normal
exercise-induced desaturation
sputum often fails to show PCP, bronchoalveolar lavage (BAL) often needed to demonstrate PCP (silver stain shows characteristic cysts)
Viral meningitis treatment?
IV ceftriaxone
IV amoxicillin is also used if immunocomprimised
HPV types caused by genital warts?
HPV 6 and 11
What is Jarisch-Herxheimer reaction?
Complication of syphilis treatment, or other spirochete infections, with antibiotics and is associated with flushing, nausea, tachycardia, and headaches. It is managed supportively and antibiotics should continue. In the context of the symptoms and management suggesting syphilis, as well as the timing of the symptom onset, this is the most likely answer.
Management of a soliatary keratinised wart?
Cryotherapy
Management of multiple non-keratinised warts?
Topical podophyllum
Most common cause of primary syphillis?
Treponema pallium
First line for BV?
Metronidazole
First line for human bite?
Co-amoxiclav
First line for campylobacter?
Clarithromycin
Management of infectious mononucleosis?
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
TB medication memory aid?
RifamPEEcin
E for ethambutol, e for eyes
IsoNERVEzid
Pyrazinamide - p for pain
CT findings in toxoplasmosis?
usually single or multiple ring enhancing lesions, mass effect may be seen
What accounts for 50% of cerebral lesions in patient’s with HIV?
Toxoplasmosis
s prophylaxis for contacts of patients with meningococcal meningitis
Oral ciprofloxacin or rifampicin
Mangement of cerebral toxoplasmosis?
pyrimethamine plus sulphadiazine for at least 6 weeks
antibiotic of choice for cellulitis in pregnancy if the patient is penicillin allergic?
Erythromycin
What should be monitoried in syphillis to assess the response?
nontreponemal (RPR/VDRL) titres should be monitored after treatment to assess the response
LP should be delayed in the following circumstances in bacterial meningitis?
signs of severe sepsis or a rapidly evolving rash
severe respiratory/cardiac compromise
significant bleeding risk
signs of raised intracranial pressure
focal neurological signs
papilloedema
continuous or uncontrolled seizures
GCS ≤ 12
Most common organism found in central line infections
Staphylococcus epidermis
Returning traveller with fever, RUQ pain? Think what?
Amoebic liver abscess
Pneumonia in an alcoholic? Think what?
Klebsiella mneumonia
most common cause of community-acquired pneumonia
Streptoccus pneumonia
Exacerbations of chronic bronchitis abx management
Amoxicillin or tetracycline or clarithromycin
Abx Management of Uncomplicated community-acquired pneumonia
Amoxicillin (Doxycycline or clarithromycin in penicillin allergic, add flucloxacillin if staphylococci suspected e.g. In influenza)
Abx management of Pneumonia possibly caused by atypical pathogens
Clarithromycin
Abx management of hospital acquired pneumonia?
Within 5 days of admission: co-amoxiclav or cefuroxime
More than 5 days after admission: piperacillin with tazobactam OR a broad-spectrum cephalosporin (e.g. ceftazidime) OR a quinolone (e.g. ciprofloxacin)
Abx of Lower UTI?
Trimethoprim or nitrofurantoin. Alternative: amoxicillin or cephalosporin
Abx management of acute pyelonephritis?
Broad-spectrum cephalosporin or quinolone
Abx management of acute prostatits?
Quinolone or trimethoprim
Abx management of impetigo?
Topical hydrogen peroxide, oral flucloxacillin or erythromycin if widespread
Abx management of cellulitis?
Flucloxacillin (clarithromycin, erythromycin or doxycycline if penicillin-allergic)
Abx management of cellulitis near the eyes or nose?
Co-amoxiclav (clarithromycin, + metronidazole if penicillin-allergic)
Management of eryiplesa?
Flucloxacillin* (clarithromycin, erythromycin or doxycycline if penicillin-allergic)
Management of animal or human bite?
Co-amoxiclav (doxycycline + metronidazole if penicillin-allergic)
Management of mastitis during breastfeeding?
Flucloxacillin
Abx Management of throat infections?
Phenoxymethylpenicillin (erythromycin alone if penicillin-allergic)
Abx Management of sinusitis
Phenoxymethylpenicillin
Abx management of otitis media?
Amoxicillin (erythromycin if penicillin-allergic)
Abx management of otitis externa?
Flucloxacillin (erythromycin if penicillin-allergic)
Abx management of peridontal abscess?
Amoxicillin
Abx management of gingivitis?
Metronidazole
Abx management of gonorrhea
Intramuscular ceftriaxone
Abx management of chlamydia?
Doxycycline or azithromycin
Abx management of PID?
Oral ofloxacin + oral metronidazole or intramuscular ceftriaxone + oral doxycycline + oral metronidazole
Abx management of syphillis?
Benzathine benzylpenicillin or doxycycline or erythromycin
Abx management of BV?
Oral or topical metronidazole or topical clindamycin
Abx management of campylobacter enteritis?
Clarithromycin
Abx management of salmonella?
Ciprofloxacin
Abx management of shigellosis
Ciprofloxacin
prophylaxis for contacts of patients with meningococcal meningitis
Oral ciprofloxacin or rifampicin
Causes of viral meningitis?
non-polio enteroviruses e.g. coxsackie virus, echovirus
mumps
herpes simplex virus (HSV), cytomegalovirus (CMV), herpes zoster viruses
HIV
measles
Features of giardiasis?
often asymptomatic
non-bloody diarrhoea
steatorrhoea
bloating, abdominal pain
lethargy
flatulence
weight loss
malabsorption and lactose intolerance can occur
Features of aemobic dysentry?
profuse, bloody diarrhoea
there may be a long incubation period
stool microscopy may show trophozoites if examined within 15 minutes or kept warm (known as a ‘hot stool’)
Treatment of amioebeiasis dysentry?
oral metronidazole
a ‘luminal agent’ (to eliminate intraluminal cysts) is recommended usually as well e.g. diloxanide furoate
Management of. anamoebic liver abscess?
oral metronidazole
a ‘luminal agent’ (to eliminate intraluminal cysts) is recommended usually as well e.g. diloxanide furoate
Features of typhoid?
initially systemic upset as above
relative bradycardia
abdominal pain, distension
constipation: although Salmonella is a recognised cause of diarrhoea, constipation is more common in typhoid
rose spots: present on the trunk in 40% of patients, and are more common in paratyphoid
What is RSV seen in?
Bronchiolitis
What is parainfuenza virus seen in?
Croup
What is rhinovirus seen in?
Common cold
What is influenza virus seen in?
Flu
What is streptococcus pneumonia seen in?
The most common cause of community-acquired pneumonia
What is haemophilus influenza seen in?
Community-acquired pneumonia
Most common cause of bronchiectasis exacerbations
Acute epiglottitis
What is Staph aureus seen in?
Pneumonia, particularly following influenza
What is mycoplasm pneumonia seen in?
Atypical pneumonia
Flu-like symptoms classically precede a dry cough. Complications include haemolytic anaemia and erythema multiforme
What is legionella pneumonipholia seen in?
Atypical pneumonia
Classically spread by air-conditioning systems, causes dry cough. Lymphopenia, deranged liver function tests and hyponatraemia may be seen
What is Pneumocystis jiroveci seen in?
Common cause of pneumonia in HIV patients. Typically patients have few chest signs and develop exertional dyspnoea
What is Mycobacterium tuberculosis seen in?
Causes tuberculosis. A wide range of presentations from asymptomatic to disseminated disease are possible. Cough, night sweats and weight loss may be seen
Investigations for mycoplasm pneumonia?
diagnosis is generally by Mycoplasma serology
positive cold agglutination test → peripheral blood smear may show red blood cell agglutination
Management of mycoplasm pneumonia?
doxycycline or a macrolide (e.g. erythromycin/clarithromycin)
Malignancies associated with EBV infection
Burkitt’s lymphoma*
Hodgkin’s lymphoma
nasopharyngeal carcinoma
HIV-associated central nervous system lymphomas
What is lichen planus?
can affect the oral mucosa, however, lesions are typically more painful and pruritic (though they can be asymptomatic), with a reticulated pattern
What is oral hairy leukoplakia?
white patches on the tongue, usually on the lateral borders. The patient’s social circumstances make her high risk for HIV exposure. These patches are painless or give only mild discomfort, and often go unnoticed. They cannot be removed from the tongue with light pressure. Treatment is non-specific, and the condition usually improves if antiretroviral therapy is started early.
Genital ulcers painful vs painless?
painful: herpes much more common than chancroid
painless: syphilis more common than lymphogranuloma venereum
What is chancroid?
Tropical disease caused by Haemophilus ducreyi. It causes painful genital ulcers associated with unilateral, painful inguinal lymph node enlargement. The ulcers typically have a sharply defined, ragged, undermined border
What us lymphogranuloma verenulum?
caused by Chlamydia trachomatis. Typically infection comprises of three stages
stage 1: small painless pustule which later forms an ulcer
stage 2: painful inguinal lymphadenopathy
stage 3: proctocolitis
Treated with doxyxyline
adverse effect of metronidazole
disulfiram-like reaction with alcohol
increases the anticoagulant effect of warfarin
The following antibiotics are commonly used in the treatment of MRSA infections
vancomycin
teicoplanin
linezolid
Patient has had a full course of tetanus vaccines, with the last dose < 10 years ago and gets tetanus
no vaccine nor tetanus immunoglobulin is required, regardless of the wound severity
Patient has had a full course of tetanus vaccines, with the last dose > 10 years ago tetanus management
if tetanus prone wound: reinforcing dose of vaccine
high-risk wounds (e.g. compound fractures, delayed surgical intervention, significant degree of devitalised tissue): reinforcing dose of vaccine + tetanus immunoglobulin
vaccine history unknown tetanus history
reinforcing dose of vaccine, regardless of the wound severity
for tetanus prone and high-risk wounds: reinforcing dose of vaccine + tetanus immunoglobulin
wHAT IS cutaneous leishmaniasis?
caused by Leishmania tropica or Leishmania mexicana
crusted lesion at the site of bite
there may be an underlying ulcer
How is cutaneus leishmaniasis diagnosed?
doing a punch biopsy from the edge of the lesion allowing for both histology and culture
What is mucocutaneous leishmaniasis most commonly caused by?
caused by Leishmania braziliensis
What is visceral leishmaniasis most commonly caused by?
Leishmania donovani
Inital empirical therapy for less than 3 months in bacterial meningitis?
ntravenous cefotaxime + amoxicillin (or ampicillin)
Initial empirical therapy aged 3 months - 50 years for bacterial meningitis
Intravenous cefotaxime (or ceftriaxone)
Initial empirical therapy aged > 50 years management
Intravenous cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin)
Diagnosis of infectious mono?
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.
First line abx for campylobacter?
Clarithromycin
Live attenuated vaccines?
M - MMR
I - Influenza (intranasal)
B - BCG
O - Oral rotavirus
O - Oral polio
T - Typhoid
Y - Yellow fever
What is hepatitis A?
RNA virus that is spread by the faecal-oral route. It is very common and particularly associated with travellers. Treatment is supportive because the condition is usually self-limiting. Hepatitis A infection has a short incubation period of 15 to 50 days which would also fit with this scenario.
How do chancroid ulcers present?
sharply defined, ragged, undermined border
Diagnosis of meningitis if concerns of raised ICP?
Whole blood PCR and blood cultures
Mneumonic for TB drug siude effects?
Rifampicin - R for Red secretions
Isoniazid - Is for Ice, which would numb you, so neuropathy
Pyrazinamide - Pyra as in Pyramid-like-crystal, so gout
Ethambutol - E for Eyes, so visual problems
Prediminant overgrowth in BV?
Gardnerella vaginalis
Features of yellow fever?
may cause mild flu-like illness lasting less than one week
classic description involves sudden onset of high fever, rigors, nausea & vomiting. Bradycardia may develop. A brief remission is followed by jaundice, haematemesis, oliguria
if severe jaundice, haematemesis may occur
Councilman bodies (inclusion bodies) may be seen in the hepatocytes
Manageemnt of Pneumocysitis jiroveci pneum,onia?
co-trimoxazole
IV pentamidine in severe cases
aerosolized pentamidine is an alternative treatment for Pneumocystis jiroveci pneumonia but is less effective with a risk of pneumothorax
steroids if hypoxic (if pO2 < 9.3kPa then steroids reduce risk of respiratory failure by 50% and death by a third)
Treatment of chlaymdia in pregnancy?
Azithromycin, erythromycin or amoxicillin
Treatment of trichmonoas vaginalis?
Oral metronidazole
First line for multiple non keratinised warts?
topical podophyllum or cryotherapy
How to remember that staphylococcus is in clusters?
I like to think of Staph as ‘staphyl’, i.e the latin for bunch of grapes. I know we all speak latin already but just a quick memory jog! Bonus fortuna et studeo!
Memory aid for remeber streptococcus is in chains
striptococcus’, i.e. they grow in strips or chains.
HIV drugs that end with -navir memory aid
‘Navir tease a pro’: HIV drugs that end with -navir are protease inhibitors e.g. ritonavir
Memroy aid for HIV drugs that end with -gravir
‘It’s grave/great you integrate’: HIV drugs that end with -gravir are integrase inhibitors e.g. raltegravir
How to remeber action of maraviroc and enfurvirtide?
Man holding back rock and tide
How to remeber non nucruotride reversaste transcripatese inhibitors?
Have vir in the middle
Two main forms of trypanosomiasis?
Two main form of this protozoal disease are recognised - African trypanosomiasis (sleeping sickness) and American trypanosomiasis (Chagas’ disease).
What is trypanosomiasis gambiense and rhodesinse spread by?
Tsetse fly
Features of trypanosmoiasis gambiense and rhodesinse?
Trypanosoma chancre - painless subcutaneous nodule at site of infection
intermittent fever
enlargement of posterior cervical lymph nodes
later: central nervous system involvement e.g. somnolence, headaches, mood changes, meningoencephalitis
mANAGEEMTN OF trypnosomiasis gambiense and rhodesinse?
early disease: IV pentamidine or suramin
later disease or central nervous system involvement: IV melarsoprol
What is chagas disease caused by?
Trypanosoma cruzi
Management of chagas disease?
treatment is most effective in the acute phase using azole or nitroderivatives such as benznidazole or nifurtimox
chronic disease management involves treating the complications e.g., heart failure
Centers for Disease Control and Prevention diagnostic criteria for staphylococcal toxic shock syndrome?
fever: temperature > 38.9ºC
hypotension: systolic blood pressure < 90 mmHg
diffuse erythematous rash
desquamation of rash, especially of the palms and soles
involvement of three or more organ systems: e.g. gastrointestinal (diarrhoea and vomiting), mucous membrane erythema, renal failure, hepatitis, thrombocytopenia, CNS involvement (e.g. confusion)
Memory ai for meningitis pre hospital treatment, treatment and prophylaxis?
Benzyl P enicillin –> Pre-hospital treatment (e.g. GP)
Cefo T axime –> T - reatment
Ci Pro floxacin –> Pro - phylaxis
What does a Positive non-treponemal test + positive treponemal test siggest?
Active syphilis
What does a Positive non-treponemal test + negative treponemal test sugggest?
consistent with a false-positive syphilis result e.g. due to pregnancy or SLE (see list above)
What does a Negative non-treponemal test + positive treponemal test suggest?
consistent with successfully treated syphilis
What is used to treat MRSA?
vancomycin
teicoplanin
linezolid
commonest cause of viral encephalitis in the adult population
HSV
csf FINDINGS IN BACRTERIAL MENINGITIS?
CSF findings in viral meningitis?
CSF findings in tuberculous meningitis?
CSF findings in fungal meningitis?
Gold standard investigation for latent TB?
Sputum sample
First line abx for campylobacter?
Clarithromycin
The most common causes of viral meningitis in adults are what?
Enteroviruses
Splenectomy? Think NHS
Neisseria meningitidis
Haemophilus influenzae
Streptococcus pneumoniae
A way of remembering the encapsulated organisms: Some Killers Have Pretty Nice Cars
S. Pneumiae
Klebsiella
H.Influenzae
P.Aeroginosa
N.Meningitidis
Criptococcus
Primary syphilis features?
chancre - painless ulcer at the site of sexual contact
local non-tender lymphadenopathy
often not seen in women (the lesion may be on the cervix)
Secondary sypholis features?
systemic symptoms: fevers, lymphadenopathy
rash on trunk, palms and soles
buccal ‘snail track’ ulcers (30%)
condylomata lata (painless, warty lesions on the genitalia )
Tertiary syphilis features?
gummas (granulomatous lesions of the skin and bones)
ascending aortic aneurysms
general paralysis of the insane
tabes dorsalis
Argyll-Robertson pupil
standard for the diagnosis and screening of HIV
combination tests (HIV p24 antigen and HIV antibody)
Fever on alternating days, think what?
Malaria
Meningitis causes in 0-3 months?
Group B Streptococcus (most common cause in neonates)
E. coli
Listeria monocytogenes
Meningitis causes in 3 months-6 years?
Neisseria meningitidis
Streptococcus pneumoniae
Haemophilus influenzae
Meningitis causes in 6 years-60 years?
Neisseria meningitidis
Streptococcus pneumoniae
Meningitis causes in mor ethan 60 years?
Streptococcus pneumoniae
Neisseria meningitidis
Listeria monocytogenes
What is Lemierre’s syndrome?
infectious thrombophlebitis of the internal jugular vein.
It most often occurs secondary to a bacterial sore throat caused by Fusobacterium necrophorum leading to a peritonsillar abscess. A combination of spread of the infection laterally from the abscess and compression lead to thrombosis of the IJV.
Features in legionella?
flu-like symptoms including fever (present in > 95% of patients)
dry cough
relative bradycardia
confusion
lymphopaenia
hyponatraemia
deranged liver function tests
pleural effusion: seen in around 30% of patients
How is cellulitis diagnosed?
Clinically
Features of leprosy?
patches of hypopigmented skin typically affecting the buttocks, face, and extensor surfaces of limbs
sensory loss
investigation of choice in genital herpes
Nucleic acid amplification tests (NAAT)
features of typhoid fever
initially systemic upset as above
relative bradycardia
abdominal pain, distension
constipation: although Salmonella is a recognised cause of diarrhoea, constipation is more common in typhoid
rose spots: present on the trunk in 40% of patients, and are more common in paratyphoid
Inactivated preparations of vaccines
rabies
hepatitis A
influenza (intramuscular)
Toxoid (inactivated toxin) vaccine
tetanus
diphtheria
pertussis
Investigations for PJP?
CXR: typically shows bilateral interstitial pulmonary infiltrates but can present with other x-ray findings e.g. lobar consolidation. May be normal
exercise-induced desaturation
sputum often fails to show PCP, bronchoalveolar lavage (BAL) often needed to demonstrate PCP (silver stain shows characteristic cysts)
mANAGEMENT OF LEGIONELLA?
treat with erythromycin/clarithromycin
What can strptococci be divided into?
alpha and beta haemolytic types
Beta haemolytic streptococci can be divided into what?
These can be subdivided into groups A-H. Only groups A, B & D are important in humans.
Disseminated gonococcal infection triad
tenosynovitis, migratory polyarthritis, dermatitis
What is most likely to cause bacterial pneumonia following influenza infection
Staph aureus
False positive VDRL/RPR in TB?
‘SomeTimes Mistakes Happen’ (SLE, TB, malaria, HIV)
If patients over 16 years need intravenous fluid resuscitation, use crystalloids that contain sodium in the range 130–154 mmol/litre with a bolus of WHAT?
500 ml over less than 15 minutes.
tREATMENT OF TOXOPLASMOSIS?
No treatment is usually required unless the patient has a severe infection or is immunosuppressed.
CT findings in primary CNS lymphma?
single or multiple homogenous enhancing lesions
Features of toxoplasmosis?
Multiple lesions
Ring or nodular enhancement
Thallium SPECT negative
Features of toxoplasmosis?
Multiple lesions
Ring or nodular enhancement
Thallium SPECT negative
Features of lymphoma?
Single lesion
Solid (homogenous) enhancement
Thallium SPECT positive
Diarrohea in HIV?
Cryptosporidium + other protozoa (most common)
Cytomegalovirus
Mycobacterium avium intracellulare
Giardia
What is streptococcus pyogenes respooinsible for?
erysipelas, impetigo, cellulitis, type 2 necrotizing fasciitis and pharyngitis/tonsillitis
When should give abx in campylobacter?
if severe symptoms (high fever, bloody diarrhoea, or more than eight stools per day) or symptoms have last more than one week
Topic BV treatment if that’s perferred?
Topical clindamycin
Incubation period of hepatitis E?
3 weeks
Chikungunya characteristics?
acute onset of fever and polyarthralgia
Erythema infectiosum (fifth disease or slapped cheek syndrome) features?
mild feverish illness which is hardly noticeable. However, in others there is a noticeable rash which appears after a few days. The rose-red rash makes the cheeks appear bright red, hence the name ‘slapped cheek syndrome’. The rash may spread to the rest of the body but unlike many other rashes, it only rarely involves the palms and soles.
Primary features of syphilis?
chancre - painless ulcer at the site of sexual contact
local non-tender lymphadenopathy
often not seen in women (the lesion may be on the cervix)
Second line management for niesseria gonorrhoea?
oral cefixime 400mg (single dose) + oral azithromycin 2g (single dose) should be used
All patients with a CD4 count lower than 200/mm3 should receive prophylaxis against what?
Pneumocystis jiroveci pneumonia
What is dengue fever?
is a viral infection that can progress to viral haemorrhagic fever (other examples include yellow fever, Lassa fever, Ebola).
Negative non-treponemal test + positive treponemal test suggest?
Successfully treated syphilis
Why should an LP be delayed in suspected bacterial meningitis?
Risk of DIC
Triad in Infectious mononucelosis?
Sore throat, pyrexia, and lymphadenopathy.
What will develop in 99% of patients who take ampicillin/amoxicillin whilst they have infectious mononucleosis
Maculopapular, pruritic rash
Risk factors for necrotising fasciitis?
skin factors: recent trauma, burns or soft tissue infections
diabetes mellitus
the most common preexisting medical condition
particularly if the patient is treated with SGLT-2 inhibitors
intravenous drug use
immunosuppression
Adverse effcts of metronidazole?
disulfiram-like reaction with alcohol
increases the anticoagulant effect of warfarin
Features of HIV seroconversion?
sore throat
lymphadenopathy
malaise, myalgia, arthralgia
diarrhoea
maculopapular rash
mouth ulcers
rarely meningoencephalitis
The classic triad in Behcet’s
oral ulcers, genital ulcers and uveitis
Legionella pneumophilia is best diagnosed by what?
Urinary antigen test
Management of primary herpes infection in pregnnacy?
Oral aciclovir 400mg tds until delivery
Features of typhoid fever?
initially systemic upset as above
relative bradycardia
abdominal pain, distension
constipation: although Salmonella is a recognised cause of diarrhoea, constipation is more common in typhoid
rose spots: present on the trunk in 40% of patients, and are more common in paratyphoid
Features of legionella?
flu-like symptoms including fever (present in > 95% of patients)
dry cough
relative bradycardia
confusion
lymphopaenia
hyponatraemia
deranged liver function tests
pleural effusion: seen in around 30% of patients
most frequent and most severe manifestation of chronic Chagas’ disease
Cardiomyopathy
e most common cause of urethritis in men after Chlamydia trachomatis and Neisseria gonorrhoea
Mycoplasma gentialium
Schistosomiasis is treated with?
Praziquantel
What is shistosoma haematobium?
Worms deposit egg clusters (pseudopapillomas) in the bladder, causing inflammation
Syphilis management in pregnancy
intramuscular benzathine penicillin is the first-line management
Complications of splenectomy?
Haemorrhage (may be early and either from short gastrics or splenic hilar vessels
Pancreatic fistula (from iatrogenic damage to pancreatic tail)
Thrombocytosis: prophylactic aspirin
Encapsulated bacteria infection e.g. Strep. pneumoniae, Haemophilus influenzae and Neisseria meningitidis
How does Kapsoi’s sarcoma present?
presents as purple papules or plaques on the skin or mucosa (e.g. gastrointestinal and respiratory tract)
Features of mycoplasm pneumonia?
the disease typically has a prolonged and gradual onset
flu-like symptoms classically precede a dry cough
bilateral consolidation on x-ray
complications may occur as below
Investigations for mycoplasm pneumonia?
diagnosis is generally by Mycoplasma serology
positive cold agglutination test → peripheral blood smear may show red blood cell agglutination
Complications of mycoplasm pneumonia?
cold agglutins (IgM): may cause an haemolytic anaemia, thrombocytopenia
erythema multiforme, erythema nodosum
meningoencephalitis, Guillain-Barre syndrome and other immune-mediated neurological diseases
bullous myringitis: painful vesicles on the tympanic membrane
pericarditis/myocarditis
gastrointestinal: hepatitis, pancreatitis
renal: acute glomerulonephritis
Management of mycoplasm pneumonia?
doxycycline or a macrolide (e.g. erythromycin/clarithromycin)
Cause of false negative Mantoux tests include and are not limited to:
TB
AIDS
Long-term steroid use
Lymphoma
Sarcoidosis
Extremes of age
Fever
Hypoalbuminaemia
Anaemia
Lab features suggestive of Pseudomonas aeruginosa include:
Gram-negative rod
non-lactose fermenting
oxidase positive
What kind of organism is staph aureus?
Gram positive cocci
What kind of organism is proteus mirabillis?
gram-negative bacillus, and also non-lactose fermenting
Complications of hepatitis B infection
chronic hepatitis (5-10%). ‘Ground-glass’ hepatocytes may be seen on light microscopy
fulminant liver failure (1%)
hepatocellular carcinoma
glomerulonephritis
polyarteritis nodosa
cryoglobulinaemia
Treating non falciprium malaria?
In areas which are known to be chloroquine-sensitive then WHO recommend either an artemisinin-based combination therapy (ACT) or chloroquine
in areas which are known to be chloroquine-resistant an ACT should be used
ACTs should be avoided in pregnant women
patients with ovale or vivax malaria should be given primaquine following acute treatment with chloroquine to destroy liver hypnozoites and prevent relapse
The most common cause of non-falciparum malaria is what?
Plasmodium vivax
general features of malaria
fever, headache, splenomegaly
Plasmodium vivax/ovale features
cyclical fever every 48 hours. Plasmodium malariae: cyclical fever every 72 hours
Plasmodium malariae is associated with what?
Nephrotic sybdrome
Methotrexate interactions?
avoid prescribing trimethoprim or co-trimoxazole concurrently - increases risk of marrow aplasia
high-dose aspirin increases the risk of methotrexate toxicity secondary to reduced excretion
first line anti-hypertensive for pre-eclampsia in women with severe asthma
Nifedipine
What is used to detect accidental oesophageal intubation
Capnography
Looks ate end tidal carbon dioxide monitoring
Women who have been admitted with hyperemesis gravidarum are generally given what fluids?
IV normal saline with added potassium as hypokalaemia is common
Pneumocystis jiroveci penumonia is treated with what?
Co-trimaxazole
