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Finals > Infectious diseases > Flashcards

Infectious diseases Flashcards

1
Q

Cyst in woman from the middle east

A

Hydatid cyst

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2
Q

What causes gastroenteritis post a long incubation period and travelling abroad

A

Amoebiasis
Giardia

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3
Q

When is neuroimaging indicated in meningitis

A

Any signs of increased ICP
- postural headache
- focal neurology
- seizure
- very drowsy

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4
Q

criteria for taking a urine culture in women

A

Pregnant
Over 65
Non-visible or visible haematuria

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5
Q

What organism causes steatorrhoea, flatulence and foul smelling stools in a recent traveller

A

Giardiasis

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6
Q

Management of asymptomatic tick bite

A

Remove with tweezers
No need for abx

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7
Q

What is another infection to syphylis that get jarisch herxheimer reaction in

A

Lyme disease

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8
Q

What give for cellulitis on the face

A

Co-amox

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9
Q

Presentation of chancroid

A

Painful genital ulcers which were initially papules or pustules- have sharply defined ragged border
Unilateral painful inguinal lymphadenopathy
Travel to africa

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10
Q

Management of UTI post partum

A

Trimethoprin

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11
Q

Gastroenteritis with a prodrome of feeling unwell

A

Campylobacter jejuni

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12
Q

Management of toxoplasmosis

A

Only treat if immunocompromised or severe infection in immunocompetent
- pyrimethamine and sulphadiazine (sulphonamide abx)

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13
Q

How long treat UTI in non pregnant women

A

3 days

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14
Q

Most common cause of viral meningitis

A

Enteroviruses- cocksackie

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15
Q

What is needed for pregnant women with a UTI after treatment

A

Test of cure MSU

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16
Q

Most common infection for central line infections

A

Staph epidermis

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17
Q

When are steroids not indicated in meningitis

A

Meningococcal
Shock
Post surgical
Immunocompromised

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18
Q

What do if Hep B antibodies are not at the desired levels

A

Give another dose of the vaccine

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19
Q

Investigation for spinal epidural abscess

A

MRI of whole spine as can get skip lesions

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20
Q

Presentation of spinal epidural abscess

A

Fever, back pain and neurological defect

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21
Q

What is a spinal epidural abscess

A

A spinal epidural abscess (SEA) is a collection of pus that is superficial to the dura mater (of the meninges) that cover the spinal cord. It is an emergency requiring urgent investigation and treatment to avoid progressive spinal cord damage.

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22
Q

Causes of spinal epidural abscess

A

IVDU
Immunocompromised
Post spinal surgery
Discitis

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23
Q

Presentation of staphylococcal toxic shock syndrome

A

High fever
Shock
Erythematous rash
Desquamating rash on the hands and feet
Evidence of any organ failure

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24
Q

What is used to screen for and diagnose HIV

A

Both HIV p24 antigen and HIV antibodies

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25
Q

When test for HIV after exposure

A

4 weeks

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26
Q

What do if combined test for HIV positive

A

Repeat to confirm

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27
Q

What do if combined test for HIV negative at 4 weeks post exposure

A

Offer a repeat at 12 weeks post exposure

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28
Q

What tests are done to screen HIV antibodies then what to confirm

A

ELISA then Western blot to confirm

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29
Q

How test for legionella

A

Urinary antigen

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30
Q

How test for mycoplasma pneumonia

A

Serology

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31
Q

Most common cause of diarrhoea in a HIV patient

A

Cryptosporidium

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32
Q

Presentation of clostridium botulinum infection

A

Flaccid paralsysis
Diplopia
Ataxia
Bulbar palsy

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33
Q

Management of c. botulinum

A

Antitoxin if given early

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34
Q

How does uncomplicated toxoplasmosis present

A

Resembles EBV
- fever
- malaise
- diffuse lymphadenopathy

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35
Q

Most common cause of neutropenic sepsis

A

Staph epidermis

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36
Q

What can offer to women with recurrent UTIs from sex

A

Post coital abx prophylaxis

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37
Q

Indications for treating campylobacter with clarithomycin

A

Very high fever
Bloody diarrhoea
8 or more stools a day
Immunocompromised
Symptoms over a week

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38
Q

What is first line antibiotic for campylobacter

A

Clarithomycin

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39
Q

How is yellow fever spread

A

Aedes mosquito

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40
Q

Presentation of yellow fever

A

Biphasic presentation
Initially flu like illness
- fever
- rigors
- N&V
- bradycardia
Get brief remission followed by haematemesis, bleeding, jaundice and oliguria due to liver involvement

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41
Q

Which zoonotic infection can present with bradycardia and a biphasic presentation

A

Yellow fever

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42
Q

What is most likely pathogen if present with fever, myalgia, cough and headache

A

Influenza- far more common than atypical pneumonias

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43
Q

Presentation of LGV

A

MSM with HIV
stage 1: small painless pustule which later forms a painless ulcer
stage 2: painful inguinal lymphadenopathy
stage 3: proctocolitis

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44
Q

Differentials for genital ulcers

A

HSV
Syphyllis
Chancroid
LGV

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45
Q

Management of LGV

A

Doxy

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46
Q

Management of syphilis

A

IM benxathine penicilline
Can use doxy

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47
Q

How monitor syphilis treatment

A

Using non-treponemal tests
- RPR
- VDRL

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48
Q

What counts as an adequate response to treatment to syphilis

A

A four fold decrease in titres
(e.g. 1:16 → 1:4 or 1:32 → 1:8)

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49
Q

Management of asymptomatic bacteriuria

A

No treatment
Monitor for if develop symptoms

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50
Q

NOst common cause of pneumonia in COPD

A

Haemophilus influenzae

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51
Q

Presentation of leptospirosis

A

Fever
Flu like
Conjunctival redness
Calf pain
Meningitis headache
Renal and liver failure

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52
Q

What infection causes calcification of the bladder

A

Schistosomiasis

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53
Q

Management of schistosomiasis

A

Praziquantel

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54
Q

Presentation of leprosy

A

Hypopigemented skin lesions
Sensory loss in those areas

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55
Q

What is adequate number of tetanus vaccines needed

A

5

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56
Q

What do if someone has cut but has had 5 doses of tetanus

A

Supportive management

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57
Q

How is herpes diagnosed

A

NAAT

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58
Q

What is investigation to determine TB drug sensitivities

A

Sputum culture

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59
Q

What antibiotics give if pneumonia secondary to the flu

A

Add flucloxacillin

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60
Q

What is best investigation for UTI in over 65

A

Urine culture

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61
Q

What is most common non-falciparum malaria

A

Plasmodium vivax

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62
Q

What is difference in cyclical fever time between the non-falciparum

A

Vivax and ovale- 48 hrs
Malariae- 72 hours

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63
Q

What is a hypnozoite

A

Parasite laying dormant in the liver

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64
Q

Which malaria species have hypnozoite phase

A

Vivax
Ovale

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65
Q

Which malaria species need to treat after initial treatment

A

Vivax and ovale as they have hypnozoite phase
Given primaquine

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66
Q

What use to treat vivax and ovale after initial treatment

A

Primaquine

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67
Q

Management of non-falciparum species

A

Artemisin basec combination therapy or chloroquine
ACT if chloroquine resistant species
If vivax or ovale then give primaquine after initial treatment to treat hypnozoite

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68
Q

How is lyme disease diagnosed

A

If erythema migrans present then can diagnose clinically
If unsure then ELISA for borrelia burgdorferi antibodies

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69
Q

Presentation of lyme disease

A

Initially
- erythema migrans rash
- headache
- fever
- arthralgia
- tired
Can get cardiac involvement- heart block, myocarditis
Neuro signs too

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70
Q

Management of lyme disease

A

1st line doxycycline
If CI like pregnancy then amoxicillin
If disseminated- ceftriaxone

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71
Q

How long treat UTIs for in pregnancy

A

7 days
Test of cure with culture

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72
Q

What effect does sepsis have on neutrophils

A

Can become neutropenic

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73
Q

What can cause false positive syphilis result on non-treponemal tests

A

SLE
Pregnancy
HIV
TB

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74
Q

How do non-treponemal tests work

A

Based off reactivity to cardiolipin cholesterol antigen
Is how get false results in SLE due to cardiolipin antibodies

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75
Q

What does a negative non-treponemal test + positive treponemal test suggest

A

Treated syphilis

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76
Q

What does a positive non-treponemal test + negative treponemal test suggest

A

False positive result due to SLE etc

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77
Q

Management of jarisch herxheimer reaction

A

Oral paracetamol

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78
Q

Primary syphilis presentation

A

Tender inguinal lymphadenopathy
Painless genital ulcer

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79
Q

What do if MRSA screen pre surgery etc is positive

A

Nasal mupirocin
Chlorhexidine all over skin

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80
Q

How is MRSA screened for

A

Nasal swab

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81
Q

Renal transplant patient develops bilateral infiltrates in lungs

A

CMV infiltrates

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82
Q

How does CMV present in immunocompetent

A

Infective mononucelosis like illness

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83
Q

Who is CMV retinitis seen in

A

HIV CD4<50

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84
Q

Presentation of CMV retinitis

A

Blurred vision
On fundoscopy see retinal haemorrhages and necrosis- pizza retina

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85
Q

Management of CMV retinitis

A

IV ganciclovir

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86
Q

Presentation of bacillus cereus gastroenteritis

A

Incubation period of 24 hours
Post eating rice that is undercooked or reheated

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87
Q

How best to prevent spread of norovirus

A

Hand hygiene with soap and hot water

88
Q

How is leptospirosis diagnosed

A

Serology

89
Q

When are vaccines given in relation to an elective splenectomy

A

2 weeks before

90
Q

Presenteation of disseminated gonorrhoea

A

Migratory polyarthritis
Dermatitis- dry, itchy skin
Tenosynovitis- pain on moving fingers from bent

91
Q

What do if someone on steroids or methotrexate comes into contact with someone who has varicella

A

Check if has had it in past
- if unsure check antibodies
If this negative then give VZIG

92
Q

What is lemierres syndrome

A

Infectious thrombophlebitis of the internal jugular vein. The cause is a tonsil infection which spreads to internal jugular causing an infectious thrombus

93
Q

Presentation of lemierres syndrome

A

preceding throat infection
Thrombophlebitis in neck- lump, tenderness and pain
Can get septic pulmonary emboli

94
Q

What happens when drink alcohol on metronidazole

A

Causes a disulfiram like reaction
- get flushing, nausea, sweatiness and palpitations

95
Q

Management of asymptomatic BV

A

No treatment required

96
Q

What do if s.aureus is shown to resistant to fluclox

A

Means MRSA so vancomycin

97
Q

Management of BV in pregnancy

A

Oral metronidazole

98
Q

What is post exposure regime for HIV

A

Antiretrovirals for 4 weeks
Testing at 12 weeks

99
Q

Hepatitis A presentation

A

Flu symptoms
Gastroenteritis symptoms
Fever
Hepatitis

100
Q

Should you do LP or antibiotics first in meningitis

A

You should only give antibiotics before a LP if
- can’t be done within an hour
- severe sepsis or evolving rash
- raised ICP

101
Q

Blood findings of EBV

A

Hepatitis- raised ALT
Lymphocytosis
Can get haemolytic anaemia

102
Q

Which infections can cause cold agglutins

A

Mycoplasma
EBV

103
Q

Management of EBV

A

Supportive- lots of fluids
Avoid contact sport for 4 weeks

104
Q

Best way of measuring response to HCV treatment

A

HCV RNA levels

105
Q

Campylobacter jejuni presentation

A

Attended BBQ
Prodrome of flu
Abdo pain
Bloody diarrhoea

106
Q

Presenation of tetanus

A

IVDU
Prodrome of fever, flu etc
Lockjaw
Trismus
Facial spasms
Dysphagia

107
Q

What is main risk factor for tetanus in UK

A

IVDU

108
Q

Differences in management of UTI men vs women

A

Men
- 7 day abx
- always send culture

Women
- 3 day abx unless pregnant
- culture if microscopic haematuria, pregnant or over 65

109
Q

What needs to be checked before starting terbinafine

A

LFTs

110
Q

Secondary syphilis presentation

A

Occurs 6-10 weeks post primary
Unwell- fever and lymphadeopathy
Genital warts
Snail track ulcer
Maculopapular rash on soles and hands

111
Q

Management of genital warts

A

Multiple non keratinised warts- topical podophyllum
Solitary keratinised- cryotherapy

112
Q

Second line for genital warts

A

Imiquimod

113
Q

Presentation of typhoid

A

Systemic upset initially
- fever
- headache
- dry cough
- joint pain
Then get rash- rose spots
Constipation
Splenomegaly
Bradycardia

114
Q

Presentation of c perfringens

A

Tender skin with blebs and bullae
These have foul smelling discharge

115
Q

If refuse IM ceftriaxone for gonorrhoea what give instead

A

Oral cefixime and oral azithromycin

116
Q

Presentation of HIV seroconversion

A

Flu like
- maculopapular rash
- arthralgia
- mouth ulcers
- diarrhoea

117
Q

Man being infused with vancomycin develops erythema over face and trunk, what is diagnosis

A

Red man syndrome- a common complication of infusing vancomycin too quickly

118
Q

What is red man syndrome

A

Where infuse vancomycin too quickly

119
Q

Management of PCP

A

Oral co-trimoxazole

120
Q

What do if wound and tetanus status unknown

A

Booster vaccine and tetanus IG

121
Q

How does dengue present

A

Fever
Nausea
Joint pain
Retro-orbital headache
Facial flushing
Can progress to haemorrhagic

122
Q

Blood findings of dengue

A

Thrombocytopenia

123
Q

What tropical disease classically presents with thrombocytopenia

A

Dengue
Malaria

124
Q

What are the different ERON criteria

A

1-no systemic upset and co-morbities
2- systemically unwell or systemically well with a comorbidity like venous insufficiency or PAD
3- systemic upset with hypotension, confusion etc
4- sepsis or nec fasc

125
Q

How manage cellulitis based off ERON criteria

A

1= oral abx
2= oral abx or consider admission
3 and 4- admit

126
Q

IV abx for severe cellulitis

A

Ceftriaxone
Co-amoxiclav
Clindamycin

127
Q

Second line antibiotic for MRSA

A

Linezolid

128
Q

Baseline investigations for starting TB meds

A

FBC
LFTs
U&Es
Vision testing

129
Q

Management of tetanus

A

Supportive with muscle relaxants
Tetanus immunoglobulin

130
Q

Interpreting CSF glucose in case of bacterial meningitis

A

It will be roughly half the serum level

131
Q

First line for acute pyelonephritis

A

Cefalexin or ciprofloxacin

132
Q

Complications of mycoplasma

A

AIHA
Erythema multiforme
Myocarditis
Bullous myringitis
GBS

133
Q

What is bullous myringitis

A

Painful vesicles on the tympanic membrane caused by mycoplasma

134
Q

Neurological symptoms following flu/pneumonia symptoms

A

Mycoplasma as can cause GBS

135
Q

When diagnosing chlamydia and gonorrhoea, where is swab taken from for women

A

Vulvovaginal

136
Q

What are hard to scrape off, non painful white patches on tongue of sex worker

A

Oral hairy leukoplakia as EBV driven but associated with HIV

137
Q

What causes oral hairy leukoplakia

A

EBV- associated with HIV

138
Q

What is post exposure prophylaxis regime for Hep B

A

Depends on if a responder to the vaccine
- if responds then just booster vaccine
- if a non-responder then booster vaccine and HBIG

139
Q

What causes of sore throat presents with palatal petechiae

A

EBV

140
Q

What can get hepatitis A from

A

Undercooked meat
Unclean water

141
Q

Who refer to if needlestick with known HIV

A

ED or occ health

142
Q

Pregnant woman comes in with hepatitis, what is cause

A

Hepatitis E

143
Q

How is Hep E spread

A

Faeco oral
- Undercooked pork
- Shellfish

144
Q

When add amoxicillin on to meningitis treatment

A

Over 50

145
Q

What is a calcified nodule on lateral side of lung

A

Calcified ghon focus indicating latent TB

146
Q

Management of falciparum malaria

A

Uncomplicated= artemisinin based combination therapy such as oral artemether plus lumefantrine
Severe= IV artesunate

147
Q

Management of rabies exposure from dog bites

A

If in UK no risk
If in developing country depends if vaccinated
If vaccinated then give 2 further doses of vaccine
If not then give full vaccine course and human rabies IG

148
Q

If present with LGV, what test is needed

A

HIV

149
Q

What presents with flushing all over body, headache and sweating

A

Disulfiram like reaction

150
Q

What is test for chlamydia in a male

A

NAAT on first catch urine sample

151
Q

What is diagnostic test for lyme disease

A

Immunoblot test
if ELISA positive then do it

152
Q

Antibiotic of choice for neutropenic sepsis

A

Tazocin

153
Q

Sites for possible primary syphilis ulcer lesion

A

Mouth
Anus
MOUTH

154
Q

Cholera presentation

A

Rice water diarrhoea
Hypoglycaemia
Dehydration

155
Q

Organism for tetanus

A

Clostridium tetani

156
Q

Organism for botulinism

A

Clostridium botulini

157
Q

Differentiating tetanus from botulinism

A

Both caused by clostridium bacteria and very common in IVDU
In tetanus you get a spastic paralysis with spasms but in botulinism it is a flaccid paralysis

158
Q

Management of uncomplicated toxoplasmosis

A

No treatment

159
Q

What is done for prophylaxis against PCP in HIV patients

A

If CD4 below 200 then give co-trimoxazole

160
Q

Post splenectomy, what infection are people still susceptible to despite pen V

A

Haemophilus due to production of BLs

161
Q

What pneumonia cause presents with oral ulcers

A

Strep pneumoniae

162
Q

What is prophylaxis regime for close contacts of meningitis patients

A

1 off dose of oral ciprofloxacin

163
Q

HIV patient with widespread demyelination in the brain

A

Progressive multifocal leukoencephalopathy

164
Q

What infection causes facial nerve palsy

A

Lyme disease

165
Q

What causes bloody diarrhoea with long incubation period after retunring from africa

A

Amoeba- giardiasis would not cause bloody diarrhoea

166
Q

What is seen in tertiary syphilis

A

Gummas
Aortic aneurysms
Tabes dorsalis
Argyll-robertson pupil

167
Q

What stain use for cryptosporidium

A

Ziehl neelsen

168
Q

What drug can cause a black hairy tongue

A

Tetracyclines

169
Q

What can arise in cavities left from previous TB

A

Aspergilloma

170
Q

What is used to diagnose typhoid

A

Blood cultures

171
Q

Alternative to oral metronidazole in BV

A

Topical clindamycin

172
Q

What effect does EBV have on WCC

A

Lymphocytosis but also a neutropenia

173
Q

What vaccines should IVDU be offered

A

Hep A and B
Tetanus

174
Q

Management of pubic lice

A

Malathion

175
Q

Management of amoebiasis

A

Metronidazole

176
Q

Best antibiotic for salmonella

A

Ciprofloxacin

177
Q

What causes IE within 2 months post prosthetic valve replacement

A

Staph epidermis

178
Q

RFx for staph epidermis IE

A

Recent prosthetic valve
Indwelling central line

179
Q

Management of cryptosporidium

A

Supportive

180
Q

After a solid organ transplant, what is most likely cause of widespread infection

A

CMV

181
Q

How does genital HSV present

A

Multiple painful ulcers
Tender lymphadenopathy

182
Q

Is latent TB contagious

A

No so no need to contact trace

183
Q

What eye defect most likely in raised in ICP

A

Sixth nerve palsy
Then- third nerve palsy

184
Q

What is presentation of multiple system atrophy

A

Parkinsonism
Autonomic dysfunction early
- erectile dysfunction
- atonic bladder
- postural hypotension
Cerebellar signs

185
Q

Presentation of oral hairy leukoplakia

A

White patches on side of tongue which look like hairs

186
Q

Difference in presentation discitis vs SEA vs iliopsoas abscess

A

Discitis- back pain, sepsis signs
spinal epidural abscess- back pain, fever and neurological signs
Iliopsoas abscess- fever, pain, limp, especially pain on hyperextension of hip

187
Q

Staph aureus gastroenteritis 2 main features

A

Short incubation
Lots of vomiting

188
Q

Management of periobital cellulitis

A

Urgent opthal referral

189
Q

How investigate EBV

A

WCC and monospot test in second week
If negative then repeat in week if still suspicious

190
Q

What is herpes labialis

A

Oral herpes

191
Q

Management of herpes labialis

A

Simple and immunocompetent- topical aciclovir
Oral aciclovir if large and painful, recurrent or immunosuppressed

192
Q

Management of genital herpes

A

Refer to GUM
If not willing then oral aciclovir

193
Q

Resp complications of HIV

A

PCP
Mycobacterium avium complex
TB
Aspergilloma

194
Q

Neuro complications of HIV

A

HIV dementia
Enceph from HIV or CMV
Toxoplasmosis
CNS lymphoma
Cryptococcus meningitis
JC PML

195
Q

Oral complications of HIV

A

Oral candidiasis
Hairy leukoplakia

196
Q

What are 2 conditions seen when CD4 under 50

A

CMV retinitis
MAC

197
Q

Pre exposure prophylaxis regime

A

Tenofovir and emtricitabine= 2 NRTIs

198
Q

Post exposure prophylaxis regime

A

Tenofovir and emtricitabine= 2 NRTIs
and raltegravir =Integrase inhibitor
Take within 72 hours
For 28 days

199
Q

HIV starting ART

A

2 NRTIs (emtricitabine, lamivudine, tenofovir)
Plus 1 of
- integrase inhibitors (dolutegravir etc)
- protease inhibitor (ritonavir)

200
Q

Initial malaria presentation

A

Cyclical fever
Myalgia
Headache
Anorexia, nausea
Hepato-splenomegaly

201
Q

Severe malaria complications

A

Hypoglycaemia
DIC
ARDS
Cerebral oedema
Severe anaemia

202
Q

RFx for botulism

A

Eating canned food
IVDU

203
Q

Management of leptospirosis

A

Benzylpenicillin
Doxy if allergic

204
Q

Investigation for hep A

A

Gold standard is Hep A RNA PCR
Second line- HAV-IgM

205
Q

Management of Hep A

A

Notify
Supportive
- anti emetic (metoclopramide)
- chlorphenamine for itch
- analgesia

206
Q

Diagnosing current Hep B infection

A

HbsAg
Appropriate serology

207
Q

Management of people who test positive for acute Hep B

A

Refer to gastro
Acute management generally supportive
however if severe signs of liver failure then start entecavir or tenofovir

208
Q

Chronic hep B management

A

Entecavir or tenofovir or peginterferon (provided no cirrhosis)

209
Q

What would encourage you to treat acute Hep B

A

Raised INR
High bilirubin
Systemically very unwell
Ascites

210
Q

Investigation for Hep C

A

HCV RNA

211
Q

Hep B presentation

A

Asymptomatic most of time
Unwell
Anorexia
Pain
Jaundice

212
Q

Hep C presentation

A

Normally asymptomatic
Arthralgia
Jaundice
Tired

213
Q

Chronic hep c maangement

A

Concoction of
- sofosbuvir
- simeprevir
- daclatasvir

214
Q

Chancroid organism and treatment

A

Haemophilus ducreyi
Azithromycin or ceftriaxone

215
Q

Which TB drugs cause hepatitis

A

All except ethambutol

216
Q

Eye side effect of tb medications

A

Ethambutol affects colour vision

Finals (29 decks)

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