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Finals > Infectious diseases > Flashcards

Infectious diseases Flashcards

1
Q

features of acute pyelonephritis

A

ascending infection (typically E. coli from the lower urinary tract

fever, rigors
loin pain
nausea/vomiting
symptoms of cystitis may be present:
dysuria
urinary frequency

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2
Q

treatment of acute pyelonephritis

A

signs of acute pyelonephritis - hospital admission

broad-spectrum cephalosporin or a quinolone (non-pregnant) - for 7-10 days

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3
Q

causes of amoebiasis

A

entamoeba histolytica (an amoeboid protozoan)

spread by the faecal-oral route

can be asymptomatic, cause mild diarrhoea or severe amoebic dysentery, can cause liver and colonic abscesses

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4
Q

features of amoebic dysentry

A

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
oral metronidazole
a ‘luminal agent’ (to eliminate intraluminal cysts) is recommended usually as well e.g. diloxanide furoate

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5
Q

features of amoebic liver abscess

A

single mass in the right lobe (may be multiple)

features
fever
right upper quadrant pain
systemic symptoms e.g. malaise
hepatomegaly

positive serology, USS

oral metronidazole
a ‘luminal agent’ (to eliminate intraluminal cysts) is recommended usually as well e.g. diloxanide furoate

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6
Q

management of animal bites

A

generally polymicrobial but the most common isolated organism is Pasteurella multocida

cleanse wound
co-amoxiclav
if penicillin-allergic then doxycycline + metronidazole is recommended

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7
Q

causes and management of human bites

A

Common organisms include:
Streptococci spp.
Staphylococcus aureus
Eikenella
Fusobacterium
Prevotella

co-amoxiclav

consider risk of viral infections such as HIV and hepatitis C

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8
Q

features of anthrax

A

caused by Bacillus anthracis, a Gram positive rod, spread by infected carcasses

Features
causes painless black eschar (cutaneous ‘malignant pustule’, but no pus)
typically painless and non-tender
may cause marked oedema
anthrax can cause gastrointestinal bleeding

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9
Q

management of anthrax

A

ciprofloxacin

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10
Q

indications and moa of amphotericin b

A

Used for systemic fungal infections

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11
Q

indications and moa of terbinafine

A

Commonly used in oral form to treat fungal nail infections

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12
Q

indications and moa of nystatin

A

As very toxic can only be used topically (e.g. for oral thrush)

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13
Q

features of aspergilloma

A

a mycetoma (mass-like fungus ball) which often colonises an existing lung cavity (e.g. secondary to tuberculosis, lung cancer or cystic fibrosis)

asymptomatic, cough, haemoptysis

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14
Q

effects of b. cereus poisoning

A

symptoms typically resolve within 24 hours in both syndromes

casuses diarrhoea and crampy abdominal pain

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15
Q

diagnosis of bacterial vaginosis

A

Amsel’s criteria for diagnosis of BV - 3/4 present
thin, white homogenous discharge
clue cells on microscopy: stippled vaginal epithelial cells
vaginal pH > 4.5
positive whiff test (addition of potassium hydroxide results in fishy odour)

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16
Q

management of bacterial vaginosis

A

if asymptomatic - no need for treatment

if symptomatic - oral metronidazole for 5-7 days, >50% relapse rate <3m

if pregnant - topical clindamycin

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17
Q

features of botulism

A

Clostridium botulinum - may result from eating contaminated food (e.g. tinned) or intravenous drug use

neurotoxin often affects bulbar muscles and autonomic nervous system

Features
patient usually fully conscious with no sensory disturbance
flaccid paralysis
diplopia
ataxia
bulbar palsy

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18
Q

treatment of botulism

A

botulism antitoxin and supportive care
antitoxin is only effective if given early - once toxin has bound its actions cannot be reversed

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19
Q

features of campylobacter infection

A

commonest bacterial cause of infectious intestinal disease in the UK

spread by the faecal-oral route and has an incubation period of 1-6 days

prodrome: headache malaise
diarrhoea: often bloody
abdominal pain: may mimic appendicitis

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20
Q

managment of campylobacter

A

first-line antibiotic is clarithromycin

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21
Q

features of cat scratch disease

A

generally caused by the Gram negative rod Bartonella henselae

Features
fever
history of a cat scratch
regional lymphadenopathy
headache, malaise

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22
Q

features of cellulitis

A

commonly occurs on the shins
usually unilateral
erythema
blisters and bullae may be seen with more severe disease
swelling
systemic upset
fever
malaise
nausea

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23
Q

what is a chancroid

A

caused by Haemophilus ducreyi

causes painful genital ulcers associated with unilateral, painful inguinal lymph node enlargement. The ulcers typically have a sharply defined, ragged, undermined border.

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24
Q

features of chlamydia

A

asymptomatic in around 70% of women and 50% of men
women: cervicitis (discharge, bleeding), dysuria
men: urethral discharge, dysuria

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25
Q

investigation findings in chlamydia

A

NAAT
urine - first void (men), vulvovaginal swab (women), cervical swab

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26
Q

management of chlamydia

A

doxycycline (7 day course) if first-line

if pregnant then azithromycin, erythromycin or amoxicillin

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27
Q

features of cholera

A

Overview
caused by Vibro cholerae - Gram negative bacteria

Features
profuse ‘rice water’ diarrhoea
dehydration
hypoglycaemia

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28
Q

treatment of cholera

A

oral rehydration therapy
antibiotics: doxycycline, ciprofloxacin

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29
Q

gram positive cocci examples

A

Gram-positive cocci = staphylococci + streptococci (including enterococci)

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30
Q

gram negative cocci

A

Neisseria meningitidis + Neisseria gonorrhoeae, also Moraxella catarrhalis

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31
Q

gram positive rods

A

Actinomyces
Bacillus anthracis (anthrax)
Clostridium
Diphtheria: Corynebacterium diphtheriae
Listeria monocytogenes

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32
Q

gram negative rods

A

Escherichia coli
Haemophilus influenzae
Pseudomonas aeruginosa
Salmonella sp.
Shigella sp.
Campylobacter jejuni

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33
Q

features of cryptosporidiosis

A

commonest protozoal cause of diarrhoea in the UK

Features
watery diarrhoea
abdominal cramps
fever

modified Ziehl-Neelsen stain of stool - red cysts of cryptosporidium

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34
Q

features of cutaneous larva migrans

A

dermatological condition prevalent in tropical and subtropical regions, largely attributable to cutaneous penetration and subsequent migration of nematode larvae

intensely pruritic, ‘creeping’, serpiginous, erythematous cutaneous eruption that advances over time

Treatment options revolve around anthelmintic agents, such as ivermectin or albendazole

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35
Q

features of CMV infection

A

only usually causes disease in the immunocompromised

infected cells have a ‘Owl’s eye’ appearance due to intranuclear inclusion bodies

CMV mononucleosis
CMV retinitis
CMV encephalopathy
CMV pneumonitis
CMV colitis

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36
Q

features of dengue fever

A

fever
headache (often retro-orbital)
myalgia, bone pain and arthralgia (‘break-bone fever’)
pleuritic pain
facial flushing (dengue)
maculopapular rash
haemorrhagic manifestations e.g. positive tourniquet test, petechiae, purpura/ecchymosis, epistaxis

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37
Q

features of severe dengue (dengue haemorrhagic fever)

A

this is a form of disseminated intravascular coagulation (DIC) resulting in:
thrombocytopenia
spontaneous bleeding
around 20-30% of these patients go on to develop dengue shock syndrome (DSS)

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38
Q

features of enteric fever

A

yphoid and paratyphoid are caused by Salmonella typhi and Salmonella paratyphi respectively

transmitted via the faecal-oral route

Features
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

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39
Q

malignancies associated with epstein Barr virus

A

Burkitt’s lymphoma*
Hodgkin’s lymphoma
nasopharyngeal carcinoma
HIV-associated central nervous system lymphomas
hairy leukoplakia

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40
Q

features of genital herpes

A

dysuria and pruritus
the primary infection is often more severe than recurrent episodes
headache, fever and malaise
- more common in primary episodes
tender inguinal lymphadenopathy
urinary retention

positive NAAT

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41
Q

management of genital herpes

A

saline bathing
analgesia
topical anaesthetic agents e.g. lidocaine
oral aciclovir

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42
Q

features of genital warts

A

condylomata accuminata - caused by the many varieties of the human papillomavirus HPV, especially types 6 & 11
types 16, 18, 33 - predispose to cervical cancer

small (2 - 5 mm) fleshy protuberances which are slightly pigmented
may bleed or itch

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43
Q

management of genital warts

A

topical podophyllum or cryotherapy

imiquimod

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44
Q

risk factors for giardiasis

A

caused by the flagellate protozoan Giardia lamblia

risk factors
faeco oral route
foreign travel
swimming/drinking water from a river or lake
male-male sexual contact

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45
Q

features of giardiasis

A

often asymptomatic
non-bloody diarrhoea
steatorrhoea
bloating, abdominal pain
lethargy
flatulence
weight loss
malabsorption and lactose intolerance can occur

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46
Q

investigation and management of giardiasis

A

stool microscopy for trophozoite and cysts
tool antigen detection assay

treat with metronidazole

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47
Q

features of gonorrhea

A

caused by the Gram-negative diplococcus Neisseria gonorrhoeae
any mucous membrane surface can be infected, typically genitourinary but also rectum and pharynx.

incubation period of gonorrhoea is 2-5 days

males: urethral discharge, dysuria
females: cervicitis e.g. leading to vaginal discharge
rectal and pharyngeal infection is usually asymptomatic

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48
Q

treatment of gonorrhoea

A

single dose of IM ceftriaxone 1g

if cipro sensitive single dose of oral ciprofloxacin 500mg

if ceftriaxone IM is refused - oral cefixime 400mg (single dose) + oral azithromycin 2g (single dose)

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49
Q

features of hepatitis A

A

benign, self-limiting disease
incubation period: 2-4 weeks
transmission is by faecal-oral spread

flu-like prodrome
abdominal pain: typically right upper quadrant
tender hepatomegaly
jaundice
deranged liver function tests

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50
Q

features of hepatitis B

A

spread through exposure to infected blood or body fluids, including vertical transmission
6-20w incubation

features of hepatitis B include fever, jaundice and elevated liver transaminases

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51
Q

features of hepatitis C

A

incubation period: 6-9 weeks

a transient rise in serum aminotransferases / jaundice
fatigue
arthralgia

> 50% develop chronic hepatitis

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52
Q

features of hepatitis D

A

transmitted parenterally
transmitted via bodily fluids
may be infected with hepatitis B at the same time

Co-infection: Hepatitis B and Hepatitis D infection at the same time.
Superinfection: A hepatitis B surface antigen positive patient subsequently develops a hepatitis D infection.

Superinfection is associated with high risk of fulminant hepatitis, chronic hepatitis status and cirrhosis.

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53
Q

features of hepatitis E

A

spread by the faecal-oral route
incubation period: 3-8 weeks

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54
Q

management of herpes simplex virus

A

gingivostomatitis: oral aciclovir, chlorhexidine mouthwash

cold sores: topical aciclovir although the evidence base for this is modest

genital herpes: oral aciclovir. Some patients with frequent exacerbations may benefit from longer term aciclovir

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55
Q

features of infectious mononucleosis

A

caused by the Epstein-Barr virus

classic triad of sore throat, pyrexia and lymphadenopathy

Symptoms typically resolve after 2-4 weeks.

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56
Q

diagnosis of infectious mononucleosis

A

heterophil antibody test (Monospot test)

57
Q

management of infectious mononucleosis

A

rest during the early stages, drink plenty of fluid, avoid alcohol
simple analgesia for any aches or pains
avoid contact sports for 4w

58
Q

features of legionella

A

caused by the intracellular bacterium Legionella pneumophilia - typically colonizes water tanks

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

59
Q

diagnosis and management of legionella

A

urinary antigen testing

CXR
a mid-to-lower zone predominance of patchy consolidation
pleural effusions in around 30%

treat with erythromycin/clarithromycin

60
Q

features of leprosy

A

granulomatous disease primarily affecting the peripheral nerves and skin caused by Mycobacterium leprae

Features
patches of hypopigmented skin typically affecting the buttocks, face, and extensor surfaces of limbs
sensory loss

61
Q

types of leprosy

A

Low degree of cell mediated immunity → lepromatous leprosy (‘multibacillary’)
extensive skin involvement
symmetrical nerve involvement

High degree of cell mediated immunity → tuberculoid leprosy (‘paucibacillary’)
limited skin disease
asymmetric nerve involvement → hypesthesia
hair loss

62
Q

management of leprosy

A

rifampicin, dapsone and clofazimine

63
Q

features of leptospirosis

A

early phase - due to bacteraemia, lasts around a week
may be mild or subclinical
fever
flu-like symptoms
subconjunctival suffusion (redness)/haemorrhage

second immune phase may lead to more severe disease (Weil’s disease)
acute kidney injury (seen in 50% of patients)
hepatitis: jaundice, hepatomegaly
aseptic meningitis

64
Q

investigations and management of leptospirosis

A

serology: antibodies to Leptospira develop after about 7 days
PCR
culture

high-dose benzylpenicillin or doxycycline

65
Q

features of lyme disease

A

caused by the spirochaete Borrelia burgdorferi, spread by ticks

Early features (within 30 days)
erythema migrans
‘bulls-eye’ rash 1-4 weeks after the initial bite but may present sooner
usually painless, more than 5 cm in diameter and slowlly increases in size
present in around 80% of patients.
systemic features - headache, lethargy, fever, arthralgia

66
Q

features of lymphogranuloma venereum

A

caused by Chlamydia trachomatis serovars L1, L2 and L3

stage 1: small painless pustule which later forms an ulcer
stage 2: painful inguinal lymphadenopathy
may occasionally form fistulating buboes
stage 3: proctocolitis

67
Q

treatment of lymphogranuloma venereum

A

doxycycline

68
Q

features of severe falciparum malaria

A

schizonts on a blood film
parasitaemia > 2%
hypoglycaemia
acidosis
temperature > 39 °C
severe anaemia
complications as below

69
Q

features of severe non falciparum malaria

A

general features of malaria: fever, headache, splenomegaly
Plasmodium vivax/ovale: cyclical fever every 48 hours. Plasmodium malariae: cyclical fever every 72 hours
Plasmodium malariae: is associated with nephrotic syndrome.

70
Q

treatment of falciparum malaria

A

uncomplicated falciparum malaria - artemether plus lumefantrine, artesunate plus amodiaquine, artesunate plus mefloquine

severe falciparum malaria - intravenous artesunate

71
Q

treatment of non-falciparum malaria

A

artemisinin-based combination therapy (ACT) or chloroquine

72
Q

management of suspected bacterial meningitis

A

IV access → take bloods and blood cultures

lumbar puncture
if cannot be done <1hr, give IV antibiotics after blood cultures

IV antibiotics
3 months - 50 years: cefotaxime (or ceftriaxone)
> 50 years: cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin) for adults

IV dexamethasone

73
Q

Management of patients with signs of raised intracranial pressure

A

get critical care input
secure airway + high-flow oxygen
IV access → take bloods and blood cultures
IV dexamethasone
IV antibiotics as above
arrange neuroimaging

74
Q

when to delay lumbar puncture

A

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

75
Q

suppression of MRSA from a carrier once identified

A

nose: mupirocin 2% in white soft paraffin, tds for 5 days

skin: chlorhexidine gluconate, od for 5 days. Apply all over but particularly to the axilla, groin and perineum

76
Q

antibiotics used in treatment of MRSA

A

vancomycin
teicoplanin
linezolid

77
Q

screening for MRSA

A

nasal swab and skin lesions or wounds
the swab should be wiped around the inside rim of a patient’s nose for 5 seconds
the microbiology form must be labelled ‘MRSA screen’

78
Q

features of mumps

A

caused by RNA paramyxovirus and tends to occur in winter and spring

Spread by droplets

Clinical features
fever
malaise, muscular pain
parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%

79
Q

features of mycoplasma pneumonia

A

the disease typically has a prolonged and gradual onset
flu-like symptoms classically precede a dry cough
bilateral consolidation on x-ray
complications - cold agglutins, erythema multiforme, erythema nodosum, meningoencephalitis, GBC

80
Q

investigations and managment of mycoplasma pneumonia

A

diagnosis is generally by Mycoplasma serology

doxycycline or a macrolide

81
Q

two types of necrotising fasciitis

A

Necrotising fasciitis is a medical emergency that is difficult to recognise in the early stages

type 1 is caused by mixed anaerobes and aerobes (often occurs post-surgery in diabetics). This is the most common type

type 2 is caused by Streptococcus pyogenes

82
Q

risk factors for necrotising fasciitis

A

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

83
Q

features of necrotising fasciitis

A

most commonly affected site is the perineum (Fournier’s gangrene).

Features
acute onset
pain, swelling, erythema at the affected site - rapidly worsening cellulitis with pain out of keeping with physical features
extremely tender over infected tissue with hypoaesthesia to light touch
skin necrosis and crepitus/gas gangrene are late signs
fever and tachycardia may be absent or occur late in the presentation

84
Q

management of necrotising fasciits

A

urgent surgical referral debridement
intravenous antibiotics

85
Q

features of non-gonococcal urethritis

A

purulent urethral discharge and dysuria - microscopy shows neutrophils but no Gram-negative diplococci

86
Q

potential causes of non gonococcal urethritis

A

Chlamydia trachomatis
most common cause

Mycoplasma genitalium
thought to cause more symptoms than Chlamydia

less common causes
Ureaplasma urealyticum
Trichomonas vaginalis
Escherichia coli

87
Q

definition of pyrexia of unknown origin

A

Defined as a prolonged fever of > 3 weeks which resists diagnosis after a week in hospital

88
Q

features of Q fever

A

caused by Coxiella burnetii, a rickettsia

originates from abattoir, cattle/sheep or it may be inhaled from infected dust

typically prodrome: fever, malaise
causes pyrexia of unknown origin
transaminitis
atypical pneumonia
endocarditis (culture-negative)

89
Q

management of q fever

A

doxycycline

90
Q

features of rabies

A

prodrome: headache, fever, agitation
hydrophobia: water-provoking muscle spasms
hypersalivation
Negri bodies: cytoplasmic inclusion bodies found in infected neurons

fatal if untreated

91
Q

acute features of schistosomiasis

A

typically only develop in people who travel to endemic areas, as they don’t have any immunity to the worms

swimmers’ itch
acute schistosomiasis syndrome (Katayama fever)
fever
urticaria/angioedema
arthralgia/myalgia
cough
diarrhoea
eosinophilia

92
Q

features of chronic schistosomiasis infection

A

worms deposit egg clusters (pseudopapillomas) in the bladder, causing inflammation

can cause an obstructive uropathy and kidney damage, frequency, haematuria and bladder calcification

typically presents as a ‘swimmer’s itch’ in patients who have recently returned from Africa

93
Q

treatment of schistosomiasis

A

single oral dose of praziquantel

94
Q

sepsis vs septic shock

A

sepsis: life-threatening organ dysfunction caused by a dysregulated host response to infection

septic shock: a more severe form sepsis, technically defined as ‘in which circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone’

95
Q

features of spinal epidural abscess

A

a collection of pus that is superficial to the dura mater (of the meninges) that cover the spinal cord

fever
back pain
focal neurological deficits according to the segment of the cord affected

96
Q

causes of spinal epidural abscess

A

most common causative micro-organism is Staphylococcus aureus.

bacteria enters the spinal epidural space by contiguous spread from adjacent structures (e.g. discitis), haematogenous spread from concomitant infection (e.g. bacteraemia from IVDU), or by direct infection (e.g. spinal surgery)

97
Q

features of staphylococcal toxic shock syndrome

A

a severe systemic reaction to staphylococcal exotoxins

fever: temperature > 38.9ºC
hypotension: systolic blood pressure < 90 mmHg
diffuse erythematous rash
desquamation of rash, especially of the palms and soles
involvement of 3 or more organ systems - gastrointestinal (diarrhoea and vomiting), mucous membrane erythema, renal failure, hepatitis, thrombocytopenia, CNS involvement (e.g. confusion)

98
Q

treatment of staphylococcal toxic shock syndrome

A

removal of infection focus (e.g. retained tampon)
IV fluids
IV antibiotics

99
Q

features of strongyloides stercoralis

A

a human parasitic nematode worm

diarrhoea
abdominal pain/bloating
papulovesicular lesions where the skin has been penetrated by infective larvae e.g. soles of feet and buttocks
larva currens: pruritic, linear, urticarial rash
if the larvae migrate to the lungs a pneumonitis similar to Loeffler’s syndrome may be triggered

100
Q

treatment of strongyloides stercoralis

A

ivermectin and albendazole are used

101
Q

primary features of syphilis

A

a sexually transmitted infection caused by the spirochaete Treponema pallidum

characterised by primary, secondary and tertiary stages

incubation period is between 9-90 days

Primary 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)

102
Q

secondary features of syphilis

A

Secondary features - occurs 6-10 weeks after primary infection

systemic symptoms: fevers, lymphadenopathy
rash on trunk, palms and soles
buccal ‘snail track’ ulcers (30%)
condylomata lata (painless, warty lesions on the genitalia )

103
Q

tertiary features of syphilis

A

gummas (granulomatous lesions of the skin and bones)
ascending aortic aneurysms
general paralysis of the insane
tabes dorsalis
Argyll-Robertson pupil

104
Q

testing for syphilis

A

non-treponemal tests
not specific for syphilis, therefore may result in false positives - RPR, VDRL
becomes negative after treatment

reponemal-specific tests
generally more complex and expensive but specific for syphilis - TP-EIA, TPHA

105
Q

management of syphilis

A

intramuscular benzathine penicillin is the first-line management

alternatives: doxycycline

106
Q

describe the Jarisch-Herxheimer reaction

A

occurs following treatment for syphilis

fever, rash, tachycardia after the first dose of antibiotic
in contrast to anaphylaxis, there is no wheeze or hypotension
it is thought to be due to the release of endotoxins following bacterial death and typically occurs within a few hours of treatment
no treatment is needed other than antipyretics if required

107
Q

features of tetanus infection

A

prodrome fever, lethargy, headache
trismus (lockjaw)
risus sardonicus: facial spasms
opisthotonus (arched back, hyperextended neck)
spasms (e.g. dysphagia)

108
Q

management of tetanus infection

A

supportive therapy including ventilatory support and muscle relaxants

intramuscular human tetanus immunoglobulin for high-risk wounds

metronidazole - first line

109
Q

features of toxoplasmosis infection in immunosuppressed patient

A

Cerebral toxoplasmosis accounts for around 50% of cerebral lesions in patients with HIV
constitutional symptoms, headache, confusion, drowsiness
CT: usually single or multiple ring-enhancing lesions, mass effect may be seen
management: pyrimethamine plus sulphadiazine for at least 6 weeks

110
Q

features of toxoplasmosis in immunocompetent patients

A

Most infections are asymptomatic. Symptomatic patients usually have a self-limiting infection, often having clinical features resembling infectious mononucleosis (fever, malaise, lymphadenopathy)

111
Q

features of trichomonas vaginalis

A

Trichomonas vaginalis is a highly motile, flagellated protozoan parasite. Trichomoniasis is a sexually transmitted infection (STI)

vaginal discharge: offensive, yellow/green, frothy
vulvovaginitis
strawberry cervix
pH > 4.5
in men is usually asymptomatic but may cause urethritis

112
Q

treatment of trichomonas vaginalis

A

oral metronidazole for 5-7 days, although the BNF also supports the use of a one-off dose of 2g metronidazole

113
Q

features of trypanosomiasis

A

African trypanosomiasis (sleeping sickness) and American trypanosomiasis (Chagas’ disease)

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

114
Q

management of trypanosomiasis

A

Management
early disease: IV pentamidine or suramin
later disease or central nervous system involvement: IV melarsoprol

115
Q

treatment of latent tuberculosis

A

3 months of isoniazid (with pyridoxine) and rifampicin, or
6 months of isoniazid (with pyridoxine)

116
Q

standard therapy for active tuberculosis

A

initial phase - first 2 months (RIPE)
Rifampicin - liver enzyme inducer
Isoniazid - peripheral neuropathy, agranulocytosis
Pyrazinamide - hyperuricaemia causing gout
Ethambutol - optic neuritis

Continuation phase - next 4 months
Rifampicin
Isoniazid

117
Q

investigation findings of active tuberculosis

A

Chest x-ray
upper lobe cavitation is the classical finding of reactivated TB
bilateral hilar lymphadenopathy

Sputum smear
3 specimens are needed
stained for the presence of acid-fast bacilli

sputum culture - gold standard investigation - more sensitive, can take 1-3w

NAAT - rapid diagnosis 24-48h

118
Q

causes and treatment of non specific urethritis

A

Common causes of NSU
Chlamydia trachomatis
Ureaplasma urealyticum
Mycoplasma genitalium

Treatment
oral doxycycline for 7 days or single dose of oral azithromycin

119
Q

when should urine cultures be sent in UTI (females)

A

women aged > 65 years
recurrent UTI (2 episodes in 6 months or 3 in 12 months)
pregnant women
men
visible or non-visible haematuria

120
Q

treatment of UTI (female)

A

pregnant and symptomatic - urine culture + nitrofurantoin

asymptomatic bacteruria and pregnant - urine culture , nitrofurantoin

121
Q

treatment of UTI (male)

A

immediate abx for 7 days
trimethoprim or nitrofurantoin should be offered first-line unless prostatitis is suspected
urine culture

122
Q

examples of live attenuated vaccines

A

BCG
measles, mumps, rubella (MMR)
influenza (intranasal)
oral rotavirus
oral polio
yellow fever
oral typhoid

123
Q

examples of inactivated preparations

A

rabies
hepatitis A
influenza (intramuscular)

124
Q

examples of subunit and conjugate vaccines

A

pneumococcus (conjugate)
haemophilus (conjugate)
meningococcus (conjugate)
hepatitis B
human papillomavirus

125
Q

examples of toxoid vaccines

A

tetanus
diphtheria
pertussis

126
Q

action and side effects of vancomycin

A

a glycopeptide antibiotic used in the treatment of Gram-positive infections - inhibits cell wall formation, preventing polymerisation of peptidoglycans

Adverse effects
nephrotoxicity
ototoxicity
thrombophlebitis
red man syndrome; occurs on rapid infusion of vancomycin

127
Q

causes of viral meningitis

A

Causes
non-polio enteroviruses e.g. coxsackie virus, echovirus
mumps
herpes simplex virus (HSV), cytomegalovirus (CMV), herpes zoster viruses
HIV
measles

128
Q

risk factors of viral meningitis

A

Risk factors
patients at the extremes of age (< 5 years and the elderly)
immunocompromised, e.g. patients with renal failure, with diabetes
intravenous drug users

129
Q

features of meningitis

A

inflammation of the leptomeninges and the cerebrospinal fluid of the subarachnoid space

headache
evidence of neck stiffness
photophobia (often milder than the photophobia experienced by a patient with bacterial meningitis)
confusion
fevers

130
Q

management of meningitis

A

LP

supportive management

broad spectrum abx - cefriaxone and IV aciclovir

viral meningitis - self limiting, sx improve over 7-14 days

131
Q

features of yellow fever

A

Type of viral haemorrhagic fever (also dengue fever, Lassa fever, Ebola).

zoonotic infection: spread by Aedes mosquitos
incubation period = 2 - 14 days

may cause mild flu-like illness lasting less than one week

sudden onset of high fever, rigors, nausea & vomiting. Bradycardia
brief remission is followed by jaundice, haematemesis, oliguria
if severe jaundice - haematemesis
Councilman bodies (inclusion bodies) may be seen in the hepatocytes

132
Q

features of trimethoprim

A

interferes with DNA synthesis by inhibiting dihydrofolate reductase - may interact with methotrexate, which also inhibits dihydrofolate reductase

133
Q

adverse effects of trimethoprim

A

myelosuppression
transient rise in creatinine: trimethoprim

134
Q

action of tetracyclines

A

Mechanism of action
protein synthesis inhibitors
binds to 30S subunit blocking binding of aminoacyl-tRNA

135
Q

uses of tetracyclines

A

acne vulgaris
Lyme disease
Chlamydia
Mycoplasma pneumoniae

136
Q

action and examples of sulphonamides

A

inhibit dihydropteroate synthetase

co-trim
sulfamethoxazole
sulfasalazine
sulfonylurea

137
Q

action and indications for rifampicin

A

tuberculosis
prophylaxis for close contact with tuberculosis or meningitis
inhibits bacterial DNA dependent RNA polymerase preventing transcription of DNA into mRNA

138
Q

side effects of rifampicin

A

potent CYP450 liver enzyme inducer
hepatitis
orange secretions
flu-like symptoms

139
Q

action and adverse effects of metronidazole

A

Metronidazole is a type of antibiotic that works by forming reactive cytotoxic metabolites inside the bacteria.

Adverse effects
disulfiram-like reaction with alcohol
increases the anticoagulant effect of warfarin

Finals (27 decks)

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