Infectious Diseases Flashcards
1
Q
Acute epiglottitis is serious infection caused by….
A
Haemophilus influenzaetype B.
2
Q
rapid onset
high temperature, generally unwell
stridor
drooling of saliva
‘tripod’ position: the patient finds it easier to breathe if they are leaning forward and extending their neck in a seated position
Features of
A
Acute epiglottitis
3
Q
Management of acute epiglottitis
A
endotracheal intubation may be necessary to protect the airway
oxygen
intravenous antibiotics
4
Q
Cellulitis is most commonly caused by infection with………..1…….or less commonly………2……..
A
- Streptococcus pyogenes
- Staphylcoccus aureus
5
Q
Indications for iv antibiotics in cellulitis
A
- immunocompromized.
- Has significant lymphoedema.
- Has facial cellulitis (unless very mild) or periorbital cellulitis.
- very young (under 1 year of age) or frail.
- severe or rapidly deteriorating cellulitis
- Eron Class III or Class IV cellulitis.
6
Q
Management of cellulitis
A
- oral flucloxacillinas first-line treatment for mild/moderate cellulitis
oral clarithromycin,erythromycin (in pregnancy)or doxycycline is recommended in patients allergic to penicillin
- oral/IV co-amoxiclav, oral/IV clindamycin, IV cefuroxime or IV ceftriaxone
7
Q
Necrotising fasciitis can be classified according to the causative organism:
A
Type 1 : mixed anaerobes and aerobes(often occurs post-surgery in diabetics). This is the most common type
Type 2: caused byStreptococcus pyogenes
8
Q
Risk factors of Necrotising fasciitis
A
- skin factors: recent trauma, burns or soft tissue infections
- DM : most common & with SGLT2 inhibitors
- Iv drug use
- immunosuppression
9
Q
Management of Necrotising fasciitis
A
urgent surgical referral debridement
intravenous antibiotics
10
Q
causes painless black eschar(cutaneous ‘malignant pustule’, but no pus)
typically painless and non-tender
may cause marked oedema
GI bleeding
Features of….?
A
Anthrax
11
Q
Anthrax is caused by
A
Bacillus anthracis, a Gram positive rod
12
Q
Management of Anthrax
A
ciprofloxacin
13
Q
antibiotics are commonly used in the treatment of MRSA infections:
A
vancomycin
teicoplanin
linezolid
14
Q
Leptospirosis is caused by
A
the spirochaeteLeptospira interrogans(serogroupL. icterohaemorrhagiae)
15
Q
Leptospirosis classically being spread by contact with….?
A
infected rat urine
16
Q
6 Features of leptospirosis
A
- Fever
- Flu like symptoms
- subconjunctival
- AKI
- hepatitis: jaundice, hepatomegaly
- aseptic meningitis
17
Q
Managment of leptospirosis
A
high-dose benzylpenicillin or doxycycline
Meningism by doxycycline
18
Q
Investigations of leptospirosis
A
serology: antibodies to Leptospira develop after about 7 days
PCR
culture
19
Q
Brucellosis has an incubation period …….
A
2 - 6 weeks
20
Q
Four major species cause brucellosis in humans:
A
B. melitensis(sheep),
B. abortus(cattle),
B. canis( dogs )
B. suis(pigs).
21
Q
Features of brucellosis
A
- hepatosplenomegaly
- sacroiliitis: spinal tenderness may be seen
- osteomyelitis,
- infective endocarditis,
- meningoencephalitis,
- orchitis
- leukopenia often seen
22
Q
Treatment of brucellosis
A
doxycycline and streptomycin
23
Q
False negative tuberculin tests may be caused by:(5)
A
- miliary TB
- sarcoidosis
- HIV
- lymphoma
- very young age (e.g. < 6 months)
24
Q
The treatment forlatent tuberculosis
A
3 months of isoniazid (with pyridoxine) and rifampicin OR 6 months of isoniazid (with pyridoxine)
25
Side effects of rifampicin
hepatitis, orange secretions
flu-like symptoms
26
Side effects of isoniazid
peripheral neuropathy: prevent with pyridoxine (Vitamin B6)
hepatitis, agranulocytosis
27
Side effects of pyrazinamide
hyperuricaemia causing gout
arthralgia, myalgia
hepatitis
28
Side effects of ethambutol
optic neuritis: check visual acuity before and during treatment
29
Lyme disease is caused by ........& spread by.....
the spirochaete Borrelia burgdorferi and is spread by ticks.
30
Early features of Lyme disease
1. erythema migrans
2. systemic features
headache
lethargy
fever
arthralgia
31
Later features of Lyme disease
1. cardiovascular
- Heart block
- Peri/ myocarditis
2. Neurological
- facial nerve palsy
- radicular pain
- meningitis
32
Lyme disease can be diagnosed clinically if ........... is present
erythema migrans
33
Management of Lyme disease
Management of suspected/confirmed Lyme disease
- doxycycline if early disease.
Amoxicillin is an alternative if doxycycline is contraindicated (e.g. pregnancy)
- ceftriaxone if disseminated disease
34
3 Causes of meningitis in > 60 years
1. Streptococcus pneumoniae
2. Neisseria meningitidis
3. Listeria monocytogenes
35
2 Causes of meningitis in 6 years - 60 years
1. Neisseria meningitidis
2. Streptococcus pneumoniae
36
3 Causes of meningitis in 3 months - 6 years
1. Neisseria meningitidis
2. Streptococcus pneumoniae
3. Haemophilus influenzae
37
3 Causes of meningitis in 0 - 3 months
Group B Streptococcus (most common cause in neonates)
E. coli
Listeria monocytogenes
38
Causes of meningitis in Immunosuppressed
Listeria monocytogenes
39
warning signs of meningitis
rapidly progressive rash
poor peripheral perfusion
RR < 8 or > 30
HR < 40 or >100
GCS < 12
PH < 7.3
WBC < 4
Lactate > 4
poor response to fluid resuscitation
40
Initial empirical therapy of meningitis, aged > 50 years
IV cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin)
41
Initial empirical therapy of meningitis, aged 3 months - 50 years
IV cefotaxime (or ceftriaxone)
42
Initial empirical therapy of meningitis, aged < 3 months
IV cefotaxime + amoxicillin (or ampicillin)
43
Treatment of Meningococcal meningitis
IV benzylpenicillin or cefotaxime (or ceftriaxone)
44
Treatment of Pneumococcal meningitis or Meningitis caused by Haemophilus influenzae
IV cefotaxime (or ceftriaxone)
45
Treatment of Meningitis caused by Listeria
IV amoxicillin (or ampicillin) + gentamicin
46
Mycobacterium marinum typically presents in patients who have had an exposure to, or frequently work with ..?.
fish
47
Treatment of Mycobacterium marinum
tetracyclines, fluoroquinolones, sulfonamides and macrolides.
48
3 Risk factors of Viral meningitis
1. patients at the extremes of age (< 5 years and the elderly)
2. immunocompromised, e.g. patients with renal failure, with diabetes
3. Iv drug users
49
Listeria monocytogenes is a Gram............ which has the unusual ability to multiply at ....... temperatures.
Listeria monocytogenes is a Gram-positive bacillus which has the unusual ability to multiply at low temperatures.
50
4 Risk factors of listeria
1. elderly
2. neonates
3. immunosuppression
especially glucocorticoids
4. pregnancy
51
Management of Listeria monocytogenes
Listeria meningitis should be treated with IV amoxicillin/ampicillin and gentamicin
52
Clostridium botulinum is Gram...........
gram positive anaerobic bacillus
53
Clostridium botulinum produces botulinum toxin, a neurotoxin which irreversibly blocks
the release of acetylcholine
54
4 Features of Botulism
flaccid paralysis
diplopia
ataxia
bulbar palsy
55
Treatment of botulism
botulism antitoxin and supportive care
56
Treatment of UTI in non pregnant women
trimethoprim or nitrofurantoin for 3 days
57
Treatment of UTI in pregnancy
first-line: nitrofurantoin (should be avoided near term)
second-line: amoxicillin or cefalexin
trimethoprim is teratogenic in the first trimester and should be avoided during pregnancy
58
Swimmer's ear is caused by .......
And severe in .....
1. Pseudomonas aeruginosa.
2. Diabetic patients
59
Diphtheria is caused by the Gram ......
positive bacterium Corynebacterium diphtheriae
60
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
Features of...?
Diphtheria
61
Management of Diphtheria
IM penicillin
diphtheria antitoxin
62
incubation period of dengue fever
2 - 14 days
63
Dengue fever is caused by
Aedes mosquitos
64
high fever, rigors
nausea & vomiting.
Bradycardia .
A brief remission is followed by jaundice, haematemesis, oliguria
Features of .....?
dengue fever
65
treatment of Lassa fever
ribavirin
66
Lassa fever is contracted by contact with the excreta of
infected African rats (Mastomys rodent) or by person-to-person spread.
67
Tetanospasmin prevents the release of
GABA
68
Management of Tetanus
1. supportive therapy including ventilatory support and muscle relaxants
2. intramuscular human tetanus immunoglobulin for high-risk wounds
3. metronidazole
69
Post-splenectomy changes
1. Platelets will rise first
2. Blood film will change over following weeks, Howell-Jolly bodies will appear
3. Other blood film changes include target cells and Pappenheimer bodies
4. Increased risk of post-splenectomy sepsis
70
Post-splenectomy sepsis Typically occurs with ....... organisms
encapsulated
71
Scarlet fever is a reaction to erythrogenic toxins produced by
Group A haemolytic streptococci (usually Streptococcus pyogenes).
72
Scarlet fever is spread via
the respiratory route by inhaling or ingesting respiratory droplets or by direct contact with nose and throat discharges, (especially during sneezing and coughing).
73
Pentad of Scarlet fever
1. Fever
2. Pharyngitis
3. Cervical lymphadenopathy
4. strawberry' tongue
5. sandpaper Rash
74
Diagnosis of scarlet fever
throat swab is normally taken but antibiotic treatment should be commenced immediately, rather than waiting for the results
75
Management of Scarlet fever
1. oral penicillin V for 10 days
2. patients who have a penicillin allergy should be given azithromycin
76
When can children with Scarlet fever return to school ?
24 hours after commencing antibiotics
77
6 Complications of Scarlet fever
1. otitis media
2. Rheumatic fever
3. Acute GN
4. Meningitidis
5. Bacteraemia
6. Necrotizing fasciitis
78
Which viral hepatitis is DNA hepadnavirus?
HBV
79
incubation period of HAV
incubation period: 2-4 weeks
80
incubation period of HEV
incubation period: 3-8 weeks
81
Superinfection of HDV is associated with high risk of
fulminant hepatitis,
chronic hepatitis status
cirrhosis.
82
incubation period of HBV
incubation period is 6-20 weeks.
83
Anti-HBs level (mIU/ml) Indicates adequate response if level
> 100
84
Anti-HBs level (mIU/ml) Indicates suboptimal response if level
10 - 100
85
Anti-HBs level (mIU/ml) Indicates no response if level
< 10
86
A better response to pegylated interferon-alpha is predicted by
1. Female
2. Age < 50 years old
3. Non Asian
4. Low HBV DNA levels
5. Negative HIV
6. High degree of information on liver biopsy
87
telbivudine is
a synthetic thymidine nucleoside analogue)
88
incubation period of HCV
incubation period: 6-9 weeks
89
Breastfeeding & HCV
not contraindicated
90
Treatment of chronic hepatitis C
combination of protease inhibitors
- sofosbuvir + daclatasvir
- sofosbuvir + simeprevir
with or without ribavirin are used
91
ribavirin - 3 side-effects:
haemolytic anaemia,
cough.
Women should not become pregnant within 6 months of stopping ribavirin as it is teratogenic
92
interferon alpha - 5 side-effects
flu-like symptoms,
depression,
fatigue,
leukopenia,
thrombocytopenia
93
Treatment of H1N1 influenza
1. Oseltamivir (Tamiflu) oral medication*
2. Zanamivir (Relenza) inhaled medication*
94
side-effects of Tamiflu
nausea, vomiting, diarrhoea and headaches
95
Side effects of Zanamivir (Relenza)
may induce bronchospasm in asthmatics
96
The Salmonella group are Gram ...
are aerobic, Gram-negative rods
97
typhoid is transmitted via
faecal-oral route (also in contaminated food and water)
98
rose spots on abdomen is more common in ....?
paratyphoid
99
Complications of Typhoid and paratyphoid
1. Osteomyelitis
2. GI bleeding/ perforation
3. Meningitis
4. Cholecystitis
5. chronic carriage (1%, more likely if adult females)
100
Giardiasis is caused by
the flagellate protozoan Giardia lamblia.
101
Giardiasis is spread by
the faeco-oral route
102
Treatment of Giardiasis
metronidazole
103
In Amoebic dysentery, stool microscopy may show trophozoites if .....
examined within 15 minutes or kept warm (known as a 'hot stool')
104
Treatment of Amoebic dysentery
1. oral metronidazole
2. luminal agent' (to eliminate intraluminal cysts) is recommended usually as well e.g. diloxanide furoate
105
In Amoebic liver abscess, which lobe is usually affected ?
Right lobe
106
Treatment of Amoebic liver abscess
oral metronidazole
a 'luminal agent' (to eliminate intraluminal cysts) is recommended usually as well e.g. diloxanide furoate
107
In aspergilloma, which sign may be present on CXR ?
crescent sign
108
Cat scratch disease is generally caused by the Gram ......
negative rod Bartonella henselae
109
Cholera is caused by Gram....
Vibro cholerae - Gram negative bacteria
110
Management of cholera
oral rehydration therapy
antibiotics: doxycycline, ciprofloxacin
111
Leprosy is a granulomatous disease primarily affecting
the peripheral nerves and skin
112
Leprosy is caused by .....
Mycobacterium leprae
113
Low degree of cell mediated immunity → lepromatous leprosy
extensive skin involvement
symmetrical nerve involvement
114
High degree of cell mediated immunity → tuberculoid leprosy
limited skin disease
asymmetric nerve involvement → hypesthesia
hair loss
115
Management of leprosy
triple therapy: rifampicin, dapsone and clofazimine
116
Management of Shigella
1. usually self-limiting and does not require antibiotic treatment
2. antibiotics (e.g. ciprofloxacin) are indicated for people with severe disease, who are immunocompromised or with bloody diarrhoea
117
Q fever is caused by
Coxiella burnetii, a rickettsia.
118
Treatment of Q fever
Doxycycline
119
Q fever can cause culture negative.......
endocarditis (culture-negative)
120
Management of RABIES
1. the wound should be washed
2. if an individual is already immunised then 2 further doses of vaccine should be given
3. if not previously immunised then human rabies immunoglobulin (HRIG) should be given along with a full course of vaccination.
* If possible, the dose should be administered locally around the wound
121
Common cause of pneumonia in HIV patients.
Pneumocystis jiroveci
122
Which pathogen can cause Atypical pneumonia & haemolytic anaemia and erythema multiforme ?
Mycoplasma pneumoniae
123
Which pathogen can cause bronchiectasis exacerbations & Acute epiglottitis
Haemophilus influenzae
124
Which pathogen can cause pneumonia and herpes labialis (cold sores)?
Streptococcus pneumoniae
125
Treatment of Mycoplasma pneumoniae
doxycycline or a macrolide (e.g. erythromycin/clarithromycin)
126
Treatment of Trichomonas vaginalis and bacterial vaginosis ?
oral metronidazole for 5-7 days
127
strawberry cervix
Seen in
Trichomonas vaginalis
128
Bacterial vaginosis is caused by
Gardnerella vaginalis
129
Treatment of Cerebral toxoplasmosis
pyrimethamine plus sulphadiazine for at least 6 weeks
130
Congenital toxoplasmosis can cause
1. neurological damage
cerebral calcification
hydrocephalus
chorioretinitis
2. ophthalmic damage
retinopathy
cataracts
131
Malignancies associated with EBV infection
1. Burkitt's lymphoma*
2. Hodgkin's lymphoma
3. nasopharyngeal carcinoma
4. HIV-associated central nervous system lymphomas
132
Animal bites, the most common isolated organism is ....1...
2. Treatment
1. Pasteurella multocida.
2. cleanse wound, co-amoxiclav
if penicillin-allergic then doxycycline + metronidazole is recommended
133
1. 5 Common organisms of human bites
2. Treatment
Streptococci spp.
Staphylococcus aureus
Eikenella
Fusobacterium
Prevotella
- Co-amoxiclav is recommended
134
Campylobacter is caused by the Gram.....
-negative bacillus Campylobacter jejuni.
135
Campylobacter is spread by .....
and has an incubation period ......
the faecal-oral route
has an incubation period of 1-6 days
136
4 Complications of Campylobacter
1. Guillain-Barre syndrome
2. reactive arthritis
3. septicaemia,
4. endocarditis
137
Treatment of Campylobacter
recommend antibiotics if severe symptoms (high fever, bloody diarrhoea, or more than eight stools per day) or symptoms have last more than one week
the first-line antibiotic is clarithromycin
138
Chancroid is a tropical disease caused by ....1..
What is the features?
1. Haemophilus ducreyi
2. painful genital ulcers associated with unilateral, painful inguinal lymph node enlargement
139
HSV & pregnancy
elective caesarean section at term is advised if a primary attack of herpes occurs during pregnancy at > 28 weeks gestation
women with recurrent herpes who are pregnant should be treated with suppressive therapy and be advised that the risk of transmission to their baby is low
140
CMV encephalopathy seen in patients with .....
HIV who have low CD4 counts
141
Treatment of CMV retinitis
IV ganciclovir is the treatment of choice
142
Features of Legionnaire's disease
relative bradycardia
confusion
lymphopaenia
hyponatraemia
deranged liver function tests
143
Management of legionnaires disease
treat with erythromycin/clarithromycin
144
The classic triad of Infectious mononucleosis
1. sore throat,
2. pyrexia
3. lymphadenopathy
145
Diagnosis of Infectious mononucleosis
heterophil antibody test (Monospot test)
146
avoid playing contact sports for 4 weeks after having ( Infectious mononucleosis) glandular fever to reduce the risk of ....
splenic rupture
147
a maculopapular, pruritic rash develops in around 99% of patients who take ........................ whilst they have infectious mononucleosis
ampicillin/amoxicillin
148
Lemierre's syndrome is
infectious thrombophlebitis of the internal jugular vein.
149
Lemierre's syndrome occurs secondary to a bacterial sore throat caused by .........?
Fusobacterium necrophorum
150
Lemierre's syndrome maybe complicated by
Septic pulmonary emboli
151
incubation period of Chickenpox
incubation period = 10-21 days
152
Complications of chickenpox
1. pneumonia
2. encephalitis (
3. disseminated haemorrhagic chickenpox
4. arthritis,
5. nephritis
6. pancreatitis
153
Investigations of chlamydia in women
vulvovaginal swab is first-line
154
Investigations of chlamydia in men
the urine test is first-line
155
Treatment of chlamydia
1. doxycycline (7 day course) if first-line
2. if doxycycline is contraindicated / not tolerated then either azithromycin (1g od for one day, then 500mg od for two days) should be used
156
Gonorrhoea is caused by the Gram.....
negative diplococcus Neisseria gonorrhoeae
157
Treatment of Gonorrhoea
first-line treatment is a single dose of IM ceftriaxone 1g
158
If ceftriaxone is refused (e.g. needle-phobic) in treatment of gonorrhoea
oral cefixime 400mg (single dose) + oral azithromycin 2g (single dose) should be used
159
features of disseminated gonococcal infection
tenosynovitis
migratory polyarthritis
dermatitis (lesions can be maculopapular or vesicular)
160
Genital warts are caused by ...1..
2. predisposes to ...... cancer.
1. human papillomavirus
2. cervical cancer
161
Measles are spread by
Aerosol transmission
162
What is The most common cause of death in measles
Pneumonia
163
Complications of measles
1. Otitis media
2. Pneumonia
3. Encephalitis
4. subacute sclerosing panencephalitis: very rare, may present 5-10 years following the illness
5. febrile convulsions
6. keratoconjunctivitis, corneal ulceration
7. diarrhoea
8. increased incidence of appendicitis
9. myocarditis
164
1. Clostridia botulinum prevents acetylcholine (ACh) release leading to ...... paralysis
2. Clostridia tetani prevents the release of glycine from Renshaw cells in the spinal cord causing a ........ paralysis
1. flaccid paralysis
2. spastic paralysis
165
Diagnosis of Cryptosporidiosis
stool: modified Ziehl-Neelsen stain (acid-fast stain) of the stool may reveal the characteristic red cysts of Cryptosporidium
166
Treatment of Cryptosporidiosis
Supportive therapy
nitazoxanide may be used for immunocompromised patients
rifaximin is also sometimes used for immunocompromised patients/patients with severe disease
167
Treatment of Genital herpes
1. oral aciclovir
2. general measures include
- saline bathing
analgesia
topical anaesthetic agents e.g. lidocaine
168
Investigations of genital herpes
NAAT is the investigation of choice in genital herpes and are now considered superior to viral culture
169
Which pathogen can cause Gastroenteritis and vomiting within 6 hours, stereotypically due to rice?
Bacillus cereus
170
In Japanese encephalitis, Parkinsonian features indicate .....
basal ganglia involvement
171
Leishmaniasis is spread by the bites of ......
sandflies
172
Mucocutaneous leishmaniasis caused by
Leishmania braziliensis
173
Visceral leishmaniasis mostly caused by
Leishmania donovani
174
Cutaneous leishmaniasis caused by
Leishmania tropica or Leishmania mexicana
175
the gold standard for diagnosis of Visceral leishmaniasis
bone marrow or splenic aspirate
176
Lymphogranuloma venereum is caused by
Chlamydia trachomatis
177
Treatment of Lymphogranuloma venereum
doxycycline
178
Wuchereria bancrofti is caused by
Parasitic filarial nematode
179
Treatment of Wuchereria bancrofti
Treatment is with diethylcarbamazine
180
American trypanosomiasis, or Chagas' disease, is caused by the ......
Trypanosoma cruzi.
181
Chronic Chagas' disease mainly affects the heart and gastrointestinal tract causing......
1. myocarditis may lead to dilated cardiomyopathy (with apical atophy) and arrhythmias
2. gastrointestinal features includes megaoesophagus and megacolon causing dysphagia and constipation
182
Treatment of American trypanosomiasis, or Chagas' disease
benznidazole or nifurtimox
183
African trypanosomiasis, or sleeping sickness are spread by ......
the tsetse fly
184
Treatment of African trypanosomiasis, or sleeping sickness
early disease: IV pentamidine or suramin
later disease or central nervous system involvement: IV melarsoprol
185
What is the commonest, and most severe, type of malaria?
Falciparum malaria is
186
5 Complications of Malaria
1. cerebral malaria: seizures, coma
2. AKI
3. DIC
4. ARDS
5. Hypoglycemia
187
Feature of severe malaria
schizonts on a blood film
parasitaemia > 2%
hypoglycaemia
acidosis
temperature > 39 °C
severe anaemia
complications
188
Treatment of Severe falciparum malaria
parasite counts of more than 2% will usually need parenteral treatment
IV artesunate is now recommended by WHO in preference to intravenous quinine
if parasite count > 10% then exchange transfusion should be considered
189
Malaria: investigation
thrombocythaemia is characteristic
normochromic normocytic anaemia
normal white cell count
reticulocytosis
Blood film
190
The most common cause of non-falciparum malaria is
Plasmodium vivax
191
Plasmodium vivax/ovale: cyclical fever every ....Hrs
48 hrs
192
Plasmodium malariae: cyclical fever every .....hrs
72 hrs
193
Plasmodium malariae: is associated with
with nephrotic syndrome
194
patients with ovale or vivax malaria should be given
primaquine following acute treatment with chloroquine to destroy liver hypnozoites and prevent relapse
195
malarial prophylaxis in pregnancy
Pregnant women should be advised to avoid travelling to regions where malaria is endemic
chloroquine can be taken
proguanil: folate supplementation (5mg od) should be given
196
Syphilis is caused by
spirochaete Treponema pallidum.
197
Primary Syphilis features
chancre - painless ulcer at the site of sexual contact
local non-tender lymphadenopathy
198
Secondary Syphilis features - occurs 6-10 weeks after primary infection
fevers, lymphadenopathy
rash on trunk, palms and soles
buccal 'snail track' ulcers (30%)
condylomata lata (painless, warty lesions on the genitalia )
199
Tertiary syphilis features
granulomatous lesions of the skin and bones)
ascending aortic aneurysms
general paralysis of the insane
tabes dorsalis
Argyll-Robertson pupil
200
Features of congenital syphilis
deafness
saddle nose
keratitis
rhagades (linear scars at the angle of the mouth)
blunted upper incisor teeth (Hutchinson's teeth), 'mulberry' molars
201
7 Causes of false positive non-treponemal (cardiolipin) tests:
1. anti-phospholipid syndrome
2. SLE
3. pregnancy
4. TB
5. Leprosy
6. malaria
7. HIV
202
Positive non-treponemal test + positive treponemal test
consistent with active syphilis infection
203
Positive non-treponemal test + negative treponemal test
consistent with a false-positive syphilis result e.g. due to pregnancy or SLE
204
Negative non-treponemal test + positive treponemal test :
consistent with successfully treated syphilis
205
Syphilis: management
IM benzathine penicillin is the first-line management
alternatives: doxycycline
206
causes of genital ulcers
Behcet's disease
carcinoma
granuloma inguinale: Klebsiella granulomatis*
Lymphogranuloma venereum (LGV) is caused by Chlamydia trachomatis
Chancroid is a tropical disease caused by Haemophilus ducreyi ( painful genital ulcers )
Syphilis is caused by Treponema pallidum ( painless ulcer )
Genital herpes ( multiple painful ulcers)
207
Schistosoma haematobium is a risk factor for .............. cancer.
squamous cell bladder cancer.
208
Schistosoma mansoni and Schistosoma japonicum can lead to
can lead to progressive hepatomegaly and splenomegaly due to portal vein congestion.
209
Treatment of schistosomiasis ( bilharzia)
single oral dose of praziquantel
210
Bactericidal antibiotics
1. penicillins
2. cephalosporins
3. aminoglycosides
4. quinolones
5. nitrofurantoin
6. metronidazole
7. rifampicin
8. isoniazid
211
Bacteriostatic antibiotics
1. macrolides
2. chloramphenicol
3. tetracyclines
4. sulphonamides
5. trimethoprim
* MCTST
212
Antibiotics Inhibit RNA synthesis
rifampicin
213
Antibiotics Inhibit DNA synthesis
quinolones (e.g. ciprofloxacin)
metronidazole
sulphonamides
trimethoprim
214
Antibiotics Inhibit protein synthesis
aminoglycosides (cause misreading of mRNA)
chloramphenicol
macrolides
tetracyclines
fusidic acid
215
organisms are Gram-negative rods
Escherichia coli
Haemophilus influenzae
Pseudomonas aeruginosa
Salmonella sp.
Shigella sp.
Campylobacter jejuni
216
Gram-positive rods (bacilli)
* mnemonic = ABCD L
Actinomyces
Bacillus anthracis (anthrax)
Clostridium
Diphtheria: Corynebacterium diphtheriae
Listeria monocytogenes
217
Gram-negative cocci
Neisseria meningitidis + Neisseria gonorrhoeae, also Moraxella catarrhalis
218
3 Adverse effects of co-trimoxazole
hyperkalaemia
headache
rash (including Steven-Johnson Syndrome)
219
Trimethoprim is like methotrexate which inhibits....
inhibits dihydrofolate reductase
220
Adverse effects of Trimethoprim
myelosuppression
221
4 adverse effects of tetracyclines
discolouration of teeth
photosensitivity
angioedema
black hairy tongue
222
Tetracyclines should not be given to women who are pregnant or breastfeeding due to the risk of
discolouration of the infant's teeth.
223
disulfiram-like reaction with alcohol
Side effect of which antibiotic ?
Metronidazole
224
5 Contraindications of BCG vaccine
previous BCG vaccination
a past history of tuberculosis
HIV
pregnancy
positive tuberculin test (Heaf or Mantoux)
225
DNA viruses
1. Herpesviruses
2. HBV
3. Adenovirus
4. Parvovirus
5. Papillomavirus
6. Poxvirus
7. Polyomavirus
*2HA4Py
226
Examples of toxoid vaccines
tetanus
diphtheria
pertussis
227
Examples of Live attenuated
BCG
measles, mumps, rubella (MMR)
influenza (intranasal)
oral rotavirus
oral polio
yellow fever
oral typhoid
228
Examples of Inactivated preparations vaccines
rabies
hepatitis A
influenza (intramuscular)
229
Examples of Subunit and conjugate vaccines
pneumococcus (conjugate)
haemophilus (conjugate)
meningococcus (conjugate)
hepatitis B
human papillomavirus
230
Examples of Messenger RNA (mRNA) vaccines
COVID-19 vaccines
231
Patient has had a full course of tetanus vaccines, with the last dose < 10 years ago
no vaccine nor tetanus immunoglobulin is required, regardless of the wound severity
232
Patient has had a full course of tetanus vaccines, with the last dose > 10 years ago
1. if tetanus prone wound: reinforcing dose of vaccine
2. high-risk wounds (e.g. compound fractures, delayed surgical intervention, significant degree of devitalised tissue): reinforcing dose of vaccine + tetanus immunoglobulin
233
If tetnus vaccination history is incomplete or unknown
reinforcing dose of vaccine, regardless of the wound severity
for tetanus prone and high-risk wounds: reinforcing dose of vaccine + tetanus immunoglobulin
234
Treatment of strongyloidiasis
ivermectin and albendazole are used
235
The strongest risk factor of Melioidosis, also called Whitmore's disease
DM
236
Pubic lice are caused by.....1.....
2. Treatment
1. Phthirus pubis
2. Management of pubic lice involves application of either: malathion 0.5%, permethrin 1%, phenothrin 0.2% or carbaryl 0.5% All of these creams or lotions
* Treatment should be re-applied after 3-7 days
237
CMV retinitis is common, affecting patients who have a CD4 count <
50
238
Fundoscopy
characteristic appearance showing retinal haemorrhages and necrosis
often called 'pizza' retina
Seen in
CMV retinitis
239
Treatment of CMV retinitis
1. IV ganciclovir
treatment used to be life-long but new evidence suggests that it may be discontinued once CD4 > 150 after HAART
* alternative: IV foscarnet or cidofovir
240
4 Factors which reduce vertical transmission of HIV
maternal antiretroviral therapy
mode of delivery (caesarean section)
neonatal antiretroviral therapy
infant feeding (bottle feeding)
241
Mode of delivery in HIV
vaginal delivery is recommended if viral load is < 50 copies/ml at 36 weeks, otherwise caesarian section is recommended
zidovudine infusion should be started four hours before beginning the caesarean section
242
Neonatal antiretroviral therapy
zidovudine PO to the neonate if maternal viral load is <50 copies/ml.
Otherwise triple ART should be used. Therapy should be continued for 4-6 weeks.
243
3 Vaccines that can be used if CD4 > 200
MMR
Varicella
Yellow fever
244
Vaccines are Contraindicated in HIV-infected adults
Cholera CVD103-HgR
Influenza-intranasal
Poliomyelitis-oral (OPV)
Tuberculosis (BCG)
245
4 Possible causes of diarrhea in HIV patients
Cryptosporidium + other protozoa (most common)
Cytomegalovirus
Mycobacterium avium intracellulare
Giardia
246
Treatment of diarrhea caused by Mycobacterium avium intracellulare in HIV patients
rifabutin, ethambutol and clarithromycin
247
Immune reconstitution inflammatory syndrome is a condition generally associated with ...
with HIV/immunosuppression,
248
Which test is useful for diagnosis of neonatal HIV infection and screening blood donors
HIV RNA (qualitative or quantitative)
249
all patients with a CD4 count < 200/mm³ should receive ....... prophylaxis
Pneumocystis carinii pneumonia (PCP)
250
What is the most common complication of Pneumocystis carinii pneumonia ?
Pneumothorax
251
Treatment of Pneumocystis carinii 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 ( reduce risk of respiratory failure by 50% and death by a third)
252
infections that may be encountered by patients with HIV according to the CD4 count < 50
1. CMV retinitis
2. Mycobacterium avium-intracellulare
* cyto myco
253
4 infections that may be encountered by patients with HIV according to the CD4 count 50 - 100
1.Cryptococcal meningitis
2. Oesophageal candidiasis
3. Primary CNS lymphoma
4. Aspergillosis
* COLA
254
4 infections that may be encountered by patients with HIV according to the CD4 count 200 - 500
1. Shingles
2. Hairy leukoplakia
3. Oral thrush
4. Kaposi sarcoma
*SHOK
255
Treatment of Toxoplasmosis
sulfadiazine and pyrimethamine
256
Treatment of Primary CNS lymphoma
1. steroids
2. chemotherapy (e.g. methotrexate) + with or without whole brain irradiation.
3. Surgical may be considered for lower grade tumours
257
India ink test positive In .....?
Cryptococcus
258
Progressive multifocal leukoencephalopathy due to infection by ....
JC virus
259
ritonavir: a potent inhibitor of
the P450 system
260
What is The most common organism found in central line infections
Staph. Epidermidis
261
Live attenuated vaccination
BCG
MMR
Influenza intranasal
Yellow fever
Oral rotavirus
Oral polio
Oral typhoid
