Infectious Diseases

Question 1

Antibiotic Coverage guidelines:

Answer 1

1. Start with amoxicillin which covers Streptococci, Listeria and Enterococci.
2. Switch to co-amoxiclav to additionally cover Staphylococci, Haemophilus and E. coli.
3. Switch to piperacillin with tazobactam (tazocin) to additionally cover Pseudomonas
4. Switch to meropenem to additionally cover ESBLs
5. Add teicoplanin or vancomycin to cover MRSA
   6.Add clarithromycin or doxycycline to cover atypical bacteria

Question 2

Examples of broad-spectrum abx:

Answer 2

• Amoxicillin (penicillin)
  -Azithromycin
• Tetracyclines
• Quinolones (eg. ciprofloxacin)

Question 3

Presentation difference between Pyelonephritis and Cystitis:

Answer 3

Pyelonephritis (kidney infection): fever, loin pain, nausea and vomiting, flank pain

Cystitis (bladder infection): more urinary frequency

Question 4

Genital herpes (Herpes simplex viral infection) presentation:

Answer 4

Multiple painful genital ulcers, sexually active

if was Chlamydia or Syphillis (caused by Treponema Pallidum)= would be single painless ulcer

HPV: painless genital warts

Question 5

Cause of Genital Herpes:

Answer 5

Herpes Simplex Virus Type 2

Cold sores: are caused by Herpes Simplex Virus Type 1

Question 6

TB management and side effects:

Answer 6

R- Rifampicin: orange secretions, hepatitis
I- Isoniazid: Peripheral Neuropathy, Agranulocytosis
P- Pyrazinamide: hyperuraemia/gout and arthralgia/myalgia
E-Ethambutol: Optic neuritis

Question 7

Hepatitis: different types and presentations-

Answer 7

Hepatitis A= flu-like symptoms, RUQ pain, tender hepatomegaly, deranged LFTs, increased incidence after travelling abroad eg. South America.
- Transmission: faecal-oral route
-most make full recovery within 3-6 months
-incubation period: 2-4 weeks

Hep C and D= Blood-borne

Question 8

Common cold vs. common flu:

(Influenza)

Answer 8

Cold= more Gradual onset, rare fever, rarely muscle aches and lethargy and can carry on with most activities.

Flu= Abrupt onset, fever often, muscle aches and lethargy often

Question 9

Bacterial Meningitis: if confirmed close contact management=

Answer 9

• 1 dose of Oral Ciprofloxacin (quinolone abx.) to all close contacts within the past 7 days (as prophylactic treatment within 7 days before onset).

Presentation: Headache, Photophobia, Non-blanching rash

Question 10

Deterioration of patients with Hep B(decompensated liver failure)?

Answer 10

Hepatocellular Carcinoma

Question 11

Cholangiocarcinoma presentation:

Answer 11

• persistent jaundice, biliary colic pain, Sister Mary Joseph nodes(periumbilical lymphadenopathy), Courvoisier’s sign(palpable mass in RUQ)

Question 12

Acute Gastritis(stomach) presentation:

Answer 12

Is stomach inflammation that presents with:
- Epigastric discomfort
-Nausea and vomiting

Question 13

Enteritis(intestines) presentation:

Answer 13

Is inflammation of the intestines that present with:
- Abdo pain
-Diarrhoea

Question 14

Gastroenteritis Presentation:

Answer 14

Inflammation from stomach to intestines that presents with:
- Pain
-Nausea
-Vomiting and Diarrhoea

Most common cause= Virus eg.
Rotavirus, Norovirus, Adenovirus

Bacteria cause: E. coli, Campylobacter Jejuni, Shigella, Salmonella, Bacillus Cereus(symptoms develop soon after eating fried rice left at room temperature- spread through contaminated cooked food.

Giardia releases cysts and contaminate water/food: faecal-oral route is spread, diagnosis is made by stool testing. Mx: metronidazole

Food poisoning is a contactable disease- eg. Giardia- labs need to inform UK health agency

• very easily spread, often has family/close contact
• important to isolate the patient if in healthcare setting to prevent spread to other patients.
• key issue: is dehydration from gastroenteritis.

Question 15

C. diff presentation:

Answer 15

• Colonisation: usually asymptomatic
• Infection: diarrhoea, nausea and abdo pain

4 C’s Abx:
- Clindamycin
-Ciprofloxacin (fluoroquinolone)
-Cephalosporin
-Carbapenem (eg. meropenem)

Diagnosis: made on stool sample: C.diff antigen(glutamate dehydrogenase)/ A and B toxins (enzyme immunoassay)

Mx: Oral Vancomycin= 1st line
or Fidaxomycin

Patients need to be isolated until 48 hours after diarrhoea, there is a high recurrence rate- faecal transplant is an option.

Complications: Pseudomembranous colitis: forms yellow/white plaques in inner surface of bowel wall.
- Additional complications: Bowel Perforation or Sepsis

Question 16

Tuberculosis:

Answer 16

• Presentation: chronic cough, night sweats
  Disease progression:
  1)
  2)
  3)
  4) Latent TB

can present with cold abscess- do not have pain, redness acute signs

Risk factors: close contact, immigrants from high rate countries, immunocompromised patients, homelessness, drug users, smokers

BCG vaccine: intradermal live attenuated(weakened) vaccine, Mantoux test before given vaccine- only given if test is negative