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MRCP Part 1 > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

Acute epiglottitis is serious infection caused by….

A

Haemophilus influenzaetype B.

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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

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3
Q

Management of acute epiglottitis

A

endotracheal intubation may be necessary to protect the airway

oxygen

intravenous antibiotics

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4
Q

Cellulitis is most commonly caused by infection with………..1…….or less commonly………2……..

A
  1. Streptococcus pyogenes
  2. Staphylcoccus aureus
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5
Q

Indications for iv antibiotics in cellulitis

A
  1. immunocompromized.
  2. Has significant lymphoedema.
  3. Has facial cellulitis (unless very mild) or periorbital cellulitis.
  4. very young (under 1 year of age) or frail.
  5. severe or rapidly deteriorating cellulitis
  6. Eron Class III or Class IV cellulitis.
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6
Q

Management of cellulitis

A
  1. oral flucloxacillinas first-line treatment for mild/moderate cellulitis

oral clarithromycin,erythromycin (in pregnancy)or doxycycline is recommended in patients allergic to penicillin

  1. oral/IV co-amoxiclav, oral/IV clindamycin, IV cefuroxime or IV ceftriaxone
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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

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8
Q

Risk factors of Necrotising fasciitis

A
  1. skin factors: recent trauma, burns or soft tissue infections
  2. DM : most common & with SGLT2 inhibitors
  3. Iv drug use
  4. immunosuppression
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9
Q

Management of Necrotising fasciitis

A

urgent surgical referral debridement

intravenous antibiotics

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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

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11
Q

Anthrax is caused by

A

Bacillus anthracis, a Gram positive rod

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12
Q

Management of Anthrax

A

ciprofloxacin

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13
Q

antibiotics are commonly used in the treatment of MRSA infections:

A

vancomycin

teicoplanin

linezolid

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14
Q

Leptospirosis is caused by

A

the spirochaeteLeptospira interrogans(serogroupL. icterohaemorrhagiae)

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15
Q

Leptospirosis classically being spread by contact with….?

A

infected rat urine

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16
Q

6 Features of leptospirosis

A
  1. Fever
  2. Flu like symptoms
  3. subconjunctival
  4. AKI
  5. hepatitis: jaundice, hepatomegaly
  6. aseptic meningitis
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17
Q

Managment of leptospirosis

A

high-dose benzylpenicillin or doxycycline

Meningism by doxycycline

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18
Q

Investigations of leptospirosis

A

serology: antibodies to Leptospira develop after about 7 days

PCR

culture

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19
Q

Brucellosis has an incubation period …….

A

2 - 6 weeks

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20
Q

Four major species cause brucellosis in humans:

A

B. melitensis(sheep),

B. abortus(cattle),

B. canis( dogs )

B. suis(pigs).

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21
Q

Features of brucellosis

A
  1. hepatosplenomegaly
  2. sacroiliitis: spinal tenderness may be seen
  3. osteomyelitis,
  4. infective endocarditis,
  5. meningoencephalitis,
  6. orchitis
  7. leukopenia often seen
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22
Q

Treatment of brucellosis

A

doxycycline and streptomycin

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23
Q

False negative tuberculin tests may be caused by:(5)

A
  1. miliary TB
  2. sarcoidosis
  3. HIV
  4. lymphoma
  5. very young age (e.g. < 6 months)
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24
Q

The treatment forlatent tuberculosis

A

3 months of isoniazid (with pyridoxine) and rifampicin OR 6 months of isoniazid (with pyridoxine)

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25
Q

Side effects of rifampicin

A

hepatitis, orange secretions

flu-like symptoms

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26
Q

Side effects of isoniazid

A

peripheral neuropathy: prevent with pyridoxine (Vitamin B6)

hepatitis, agranulocytosis

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27
Q

Side effects of pyrazinamide

A

hyperuricaemia causing gout

arthralgia, myalgia

hepatitis

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28
Q

Side effects of ethambutol

A

optic neuritis: check visual acuity before and during treatment

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29
Q

Lyme disease is caused by ……..& spread by…..

A

the spirochaete Borrelia burgdorferi and is spread by ticks.

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30
Q

Early features of Lyme disease

A
  1. erythema migrans
  2. systemic features

headache

lethargy

fever

arthralgia

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31
Q

Later features of Lyme disease

A
  1. cardiovascular
    - Heart block
    - Peri/ myocarditis
  2. Neurological
    - facial nerve palsy
    - radicular pain
    - meningitis
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32
Q

Lyme disease can be diagnosed clinically if ……….. is present

A

erythema migrans

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33
Q

Management of Lyme disease

A

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
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34
Q

3 Causes of meningitis in > 60 years

A
  1. Streptococcus pneumoniae
  2. Neisseria meningitidis
  3. Listeria monocytogenes
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35
Q

2 Causes of meningitis in 6 years - 60 years

A
  1. Neisseria meningitidis
  2. Streptococcus pneumoniae
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36
Q

3 Causes of meningitis in 3 months - 6 years

A
  1. Neisseria meningitidis
  2. Streptococcus pneumoniae
  3. Haemophilus influenzae
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37
Q

3 Causes of meningitis in 0 - 3 months

A

Group BStreptococcus(most common cause in neonates)

E. coli

Listeria monocytogenes

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38
Q

Causes of meningitis in Immunosuppressed

A

Listeria monocytogenes

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39
Q

warning signs of meningitis

A

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

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40
Q

Initial empirical therapy of meningitis, aged > 50 years

A

IV cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin)

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41
Q

Initial empirical therapy of meningitis, aged 3 months - 50 years

A

IV cefotaxime (or ceftriaxone)

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42
Q

Initial empirical therapy of meningitis, aged < 3 months

A

IV cefotaxime + amoxicillin (or ampicillin)

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43
Q

Treatment of Meningococcal meningitis

A

IV benzylpenicillin or cefotaxime (or ceftriaxone)

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44
Q

Treatment of Pneumococcal meningitisor Meningitis caused byHaemophilus influenzae

A

IV cefotaxime (or ceftriaxone)

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45
Q

Treatment of Meningitis caused by Listeria

A

IV amoxicillin (or ampicillin) + gentamicin

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46
Q

Mycobacterium marinum typically presents in patients who have had an exposure to, or frequently work with ..?.

A

fish

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47
Q

Treatment of Mycobacterium marinum

A

tetracyclines, fluoroquinolones, sulfonamides and macrolides.

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48
Q

3 Risk factors of Viral meningitis

A
  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
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49
Q

Listeria monocytogenesis a Gram………… which has the unusual ability to multiply at ……. temperatures.

A

Listeria monocytogenesis a Gram-positive bacillus which has the unusual ability to multiply at low temperatures.

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50
Q

4 Risk factors of listeria

A
  1. elderly
  2. neonates
  3. immunosuppression

especially glucocorticoids

  1. pregnancy
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51
Q

Management of Listeria monocytogenes

A

Listeria meningitis should be treated with IV amoxicillin/ampicillin and gentamicin

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52
Q

Clostridium botulinum is Gram………..

A

gram positive anaerobic bacillus

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53
Q

Clostridium botulinum produces botulinum toxin, a neurotoxin which irreversibly blocks

A

the release of acetylcholine

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54
Q

4 Features of Botulism

A

flaccid paralysis

diplopia

ataxia

bulbar palsy

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55
Q

Treatment of botulism

A

botulism antitoxin and supportive care

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56
Q

Treatment of UTI in non pregnant women

A

trimethoprim or nitrofurantoin for 3 days

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57
Q

Treatment of UTI in pregnancy

A

first-line: nitrofurantoin(should be avoided near term)

second-line:amoxicillin or cefalexin

trimethoprim is teratogenicin the first trimester and should be avoided during pregnancy

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58
Q

Swimmer’s ear is caused by …….

And severe in …..

A
  1. Pseudomonas aeruginosa.
  2. Diabetic patients
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59
Q

Diphtheria is caused by the Gram ……

A

positive bacterium Corynebacterium diphtheriae

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60
Q

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…?

A

Diphtheria

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61
Q

Management of Diphtheria

A

IM penicillin

diphtheria antitoxin

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62
Q

incubation period of dengue fever

A

2 - 14 days

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63
Q

Dengue fever is caused by

A

Aedes mosquitos

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64
Q

high fever, rigors
nausea & vomiting.
Bradycardia .
A brief remission is followed by jaundice, haematemesis, oliguria

Features of …..?

A

dengue fever

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65
Q

treatment of Lassa fever

A

ribavirin

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66
Q

Lassa fever is contracted by contact with the excreta of

A

infected African rats (Mastomys rodent) or by person-to-person spread.

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67
Q

Tetanospasmin prevents the release of

A

GABA

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68
Q

Management of Tetanus

A
  1. supportive therapy including ventilatory support and muscle relaxants
  2. intramuscular human tetanus immunoglobulin for high-risk wounds
  3. metronidazole
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69
Q

Post-splenectomy changes

A
  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
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70
Q

Post-splenectomy sepsis Typically occurs with ……. organisms

A

encapsulated

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71
Q

Scarlet fever is a reaction to erythrogenic toxins produced by

A

Group A haemolytic streptococci (usuallyStreptococcus pyogenes).

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72
Q

Scarlet fever is spread via

A

the respiratory route by inhaling or ingesting respiratory droplets or by direct contact with nose and throat discharges, (especially during sneezing and coughing).

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73
Q

Pentad of Scarlet fever

A
  1. Fever
  2. Pharyngitis
  3. Cervical lymphadenopathy
  4. strawberry’ tongue
  5. sandpaper Rash
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74
Q

Diagnosis of scarlet fever

A

throat swab is normally taken but antibiotic treatment should be commenced immediately, rather than waiting for the results

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75
Q

Management of Scarlet fever

A
  1. oral penicillin V for 10 days
  2. patients who have apenicillin allergy should be given azithromycin
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76
Q

When can children with Scarlet fever return to school ?

A

24 hours after commencing antibiotics

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77
Q

6 Complications of Scarlet fever

A
  1. otitis media
  2. Rheumatic fever
  3. Acute GN
  4. Meningitidis
  5. Bacteraemia
  6. Necrotizing fasciitis
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78
Q

Which viral hepatitis is DNA hepadnavirus?

A

HBV

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79
Q

incubation period of HAV

A

incubation period: 2-4 weeks

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80
Q

incubation period of HEV

A

incubation period: 3-8 weeks

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81
Q

Superinfection of HDV is associated with high risk of

A

fulminant hepatitis,

chronic hepatitis status

cirrhosis.

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82
Q

incubation period of HBV

A

incubation period is 6-20 weeks.

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83
Q

Anti-HBs level (mIU/ml) Indicates adequate response if level

A

> 100

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84
Q

Anti-HBs level (mIU/ml) Indicates suboptimal response if level

A

10 - 100

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85
Q

Anti-HBs level (mIU/ml) Indicates no response if level

A

< 10

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86
Q

A better response to pegylated interferon-alpha is predicted by

A
  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
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87
Q

telbivudine is

A

a synthetic thymidine nucleoside analogue)

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88
Q

incubation period of HCV

A

incubation period: 6-9 weeks

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89
Q

Breastfeeding & HCV

A

not contraindicated

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90
Q

Treatment of chronic hepatitis C

A

combination of protease inhibitors
- sofosbuvir + daclatasvir
- sofosbuvir + simeprevir

with or without ribavirin are used

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91
Q

ribavirin - 3 side-effects:

A

haemolytic anaemia,

cough.

Women should not become pregnant within 6 months of stopping ribavirin as it is teratogenic

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92
Q

interferon alpha - 5 side-effects

A

flu-like symptoms,

depression,

fatigue,

leukopenia,

thrombocytopenia

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93
Q

Treatment of H1N1 influenza

A
  1. Oseltamivir (Tamiflu) oral medication*
  2. Zanamivir (Relenza) inhaled medication*
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94
Q

side-effects of Tamiflu

A

nausea, vomiting, diarrhoea and headaches

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95
Q

Side effects of Zanamivir (Relenza)

A

may induce bronchospasm in asthmatics

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96
Q

The Salmonella group are Gram …

A

are aerobic, Gram-negative rods

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97
Q

typhoid is transmitted via

A

faecal-oral route (also in contaminated food and water)

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98
Q

rose spots on abdomen is more common in ….?

A

paratyphoid

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99
Q

Complications of Typhoid and paratyphoid

A
  1. Osteomyelitis
  2. GI bleeding/ perforation
  3. Meningitis
  4. Cholecystitis
  5. chronic carriage (1%, more likely if adult females)
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100
Q

Giardiasis is caused by

A

the flagellate protozoanGiardia lamblia.

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101
Q

Giardiasis is spread by

A

the faeco-oral route

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102
Q

Treatment of Giardiasis

A

metronidazole

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103
Q

In Amoebic dysentery, stool microscopy may show trophozoites if …..

A

examined within 15 minutes or kept warm (known as a ‘hot stool’)

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104
Q

Treatment of Amoebic dysentery

A
  1. oral metronidazole
  2. luminal agent’ (to eliminate intraluminal cysts) is recommended usually as well e.g. diloxanide furoate
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Perfectly
105
Q

In Amoebic liver abscess, which lobe is usually affected ?

A

Right lobe

106
Q

Treatment of Amoebic liver abscess

A

oral metronidazole

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

107
Q

In aspergilloma, which sign may be present on CXR ?

A

crescent sign

108
Q

Cat scratch disease is generally caused by the Gram ……

A

negative rod Bartonella henselae

109
Q

Cholera is caused by Gram….

A

Vibro cholerae - Gram negative bacteria

110
Q

Management of cholera

A

oral rehydration therapy

antibiotics: doxycycline, ciprofloxacin

111
Q

Leprosy is a granulomatous disease primarily affecting

A

the peripheral nerves and skin

112
Q

Leprosy is caused by…..

A

Mycobacterium leprae

113
Q

Low degree of cell mediated immunity → lepromatous leprosy

A

extensive skin involvement

symmetrical nerve involvement

114
Q

High degree of cell mediated immunity →tuberculoid leprosy

A

limited skin disease

asymmetric nerve involvement → hypesthesia

hair loss

115
Q

Management of leprosy

A

triple therapy: rifampicin, dapsone and clofazimine

116
Q

Management of Shigella

A
  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

Q fever is caused by

A

Coxiella burnetii, a rickettsia.

118
Q

Treatment of Q fever

A

Doxycycline

119
Q

Q fever can cause culture negative…….

A

endocarditis (culture-negative)

120
Q

Management of RABIES

A
  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
Q

Common cause of pneumonia in HIV patients.

A

Pneumocystis jiroveci

122
Q

Which pathogen can cause Atypical pneumonia & haemolytic anaemia and erythema multiforme ?

A

Mycoplasma pneumoniae

123
Q

Which pathogen can cause bronchiectasis exacerbations & Acute epiglottitis

A

Haemophilus influenzae

124
Q

Which pathogen can cause pneumonia and herpes labialis (cold sores)?

A

Streptococcus pneumoniae

125
Q

Treatment of Mycoplasma pneumoniae

A

doxycycline or a macrolide(e.g. erythromycin/clarithromycin)

126
Q

Treatment of Trichomonas vaginalis and bacterial vaginosis ?

A

oral metronidazole for 5-7 days

127
Q

strawberry cervix

Seen in

A

Trichomonas vaginalis

128
Q

Bacterial vaginosis is caused by

A

Gardnerella vaginalis

129
Q

Treatment of Cerebral toxoplasmosis

A

pyrimethamine plus sulphadiazine for at least 6 weeks

130
Q

Congenital toxoplasmosis can cause

A
  1. neurological damage

cerebral calcification

hydrocephalus

chorioretinitis

  1. ophthalmic damage

retinopathy

cataracts

131
Q

Malignancies associated with EBV infection

A
  1. Burkitt’s lymphoma*
  2. Hodgkin’s lymphoma
  3. nasopharyngeal carcinoma
  4. HIV-associated central nervous system lymphomas
132
Q

Animal bites, the most common isolated organism is….1…

  1. Treatment
A
  1. Pasteurella multocida.
  2. cleanse wound, co-amoxiclav
    if penicillin-allergic then doxycycline + metronidazole is recommended
133
Q
  1. 5 Common organisms of human bites
  2. Treatment
A

Streptococci spp.

Staphylococcus aureus

Eikenella

Fusobacterium

Prevotella

  • Co-amoxiclavis recommended
134
Q

Campylobacter is caused by the Gram…..

A

-negative bacillusCampylobacter jejuni.

135
Q

Campylobacter is spread by …..

and has an incubation period ……

A

the faecal-oral route

has an incubation period of 1-6 days

136
Q

4 Complications of Campylobacter

A
  1. Guillain-Barre syndrome
  2. reactive arthritis
  3. septicaemia,
  4. endocarditis
137
Q

Treatment of Campylobacter

A

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
Q

Chancroid is a tropical disease caused by….1..

What is the features?

A
  1. Haemophilus ducreyi
  2. painful genital ulcers associated with unilateral, painful inguinal lymph node enlargement
139
Q

HSV & pregnancy

A

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
Q

CMV encephalopathy seen in patients with …..

A

HIV who have low CD4 counts

141
Q

Treatment of CMV retinitis

A

IV ganciclovir is the treatment of choice

142
Q

Features of Legionnaire’s disease

A

relative bradycardia

confusion

lymphopaenia

hyponatraemia

deranged liver function tests

143
Q

Management of legionnaires disease

A

treat with erythromycin/clarithromycin

144
Q

Theclassic triad of Infectious mononucleosis

A
  1. sore throat,
  2. pyrexia
  3. lymphadenopathy
145
Q

Diagnosis of Infectious mononucleosis

A

heterophil antibody test (Monospot test)

146
Q

avoid playing contact sports for 4 weeks after having ( Infectious mononucleosis) glandular fever to reduce the risk of ….

A

splenic rupture

147
Q

a maculopapular, pruritic rash develops in around 99% of patients who take …………………… whilst they have infectious mononucleosis

A

ampicillin/amoxicillin

148
Q

Lemierre’s syndrome is

A

infectious thrombophlebitis of the internal jugular vein.

149
Q

Lemierre’s syndrome occurs secondary to a bacterial sore throat caused by………?

A

Fusobacterium necrophorum

150
Q

Lemierre’s syndrome maybe complicated by

A

Septic pulmonary emboli

151
Q

incubation period of Chickenpox

A

incubation period = 10-21 days

152
Q

Complications of chickenpox

A
  1. pneumonia
  2. encephalitis (
  3. disseminated haemorrhagic chickenpox
  4. arthritis,
  5. nephritis
  6. pancreatitis
153
Q

Investigations of chlamydia in women

A

vulvovaginal swab is first-line

154
Q

Investigations of chlamydia in men

A

the urine test is first-line

155
Q

Treatment of chlamydia

A
  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
Q

Gonorrhoea is caused by theGram…..

A

negative diplococcusNeisseria gonorrhoeae

157
Q

Treatment of Gonorrhoea

A

first-line treatment is a single dose ofIM ceftriaxone 1g

158
Q

If ceftriaxone is refused (e.g. needle-phobic) in treatment of gonorrhoea

A

oral cefixime 400mg (single dose) + oral azithromycin 2g (single dose)should be used

159
Q

features of disseminated gonococcal infection

A

tenosynovitis

migratory polyarthritis

dermatitis(lesions can be maculopapular or vesicular)

160
Q

Genital warts are caused by …1..

  1. predisposes to …… cancer.
A
  1. human papillomavirus
  2. cervical cancer
161
Q

Measles are spread by

A

Aerosol transmission

162
Q

What is The most common cause of death in measles

A

Pneumonia

163
Q

Complications of measles

A
  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
Q
  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
A
  1. flaccid paralysis
  2. spastic paralysis
165
Q

Diagnosis of Cryptosporidiosis

A

stool:modified Ziehl-Neelsen stain(acid-fast stain) of the stool may reveal the characteristic red cysts of Cryptosporidium

166
Q

Treatment of Cryptosporidiosis

A

Supportive therapy

nitazoxanide may be used for immunocompromised patients

rifaximinis also sometimes used for immunocompromised patients/patients with severe disease

167
Q

Treatment of Genital herpes

A
  1. oral aciclovir
  2. general measures include
    - saline bathing

analgesia

topical anaesthetic agents e.g. lidocaine

168
Q

Investigations of genital herpes

A

NAATis the investigation of choice in genital herpes and are now considered superior to viral culture

169
Q

Which pathogen can cause Gastroenteritis and vomiting within 6 hours,stereotypically due to rice?

A

Bacillus cereus

170
Q

In Japanese encephalitis, Parkinsonian features indicate …..

A

basal ganglia involvement

171
Q

Leishmaniasis is spread by the bites of……

A

sandflies

172
Q

Mucocutaneous leishmaniasis caused by

A

Leishmania braziliensis

173
Q

Visceral leishmaniasis mostly caused by

A

Leishmania donovani

174
Q

Cutaneous leishmaniasis caused by

A

Leishmania tropicaorLeishmania mexicana

175
Q

the gold standard for diagnosis of Visceral leishmaniasis

A

bone marrow or splenic aspirate

176
Q

Lymphogranuloma venereum is caused by

A

Chlamydia trachomatis

177
Q

Treatment of Lymphogranuloma venereum

A

doxycycline

178
Q

Wuchereria bancrofti is caused by

A

Parasitic filarial nematode

179
Q

Treatment of Wuchereria bancrofti

A

Treatment is with diethylcarbamazine

180
Q

American trypanosomiasis, or Chagas’ disease, is caused by the ……

A

Trypanosoma cruzi.

181
Q

Chronic Chagas’ disease mainly affects the heart and gastrointestinal tract causing……

A
  1. myocarditis may lead todilated cardiomyopathy(with apical atophy) and arrhythmias
  2. gastrointestinal features includes megaoesophagus and megacolon causing dysphagia and constipation
182
Q

Treatment of American trypanosomiasis, orChagas’ disease

A

benznidazole or nifurtimox

183
Q

African trypanosomiasis, orsleeping sickness are spread by ……

A

the tsetse fly

184
Q

Treatment of African trypanosomiasis, orsleeping sickness

A

early disease: IV pentamidine or suramin

later disease or central nervous system involvement: IV melarsoprol

185
Q

What is the commonest, and most severe, type of malaria?

A

Falciparum malaria is

186
Q

5 Complications of Malaria

A
  1. cerebral malaria: seizures, coma
  2. AKI
  3. DIC
  4. ARDS
  5. Hypoglycemia
187
Q

Feature of severe malaria

A

schizonts on a blood film

parasitaemia > 2%

hypoglycaemia

acidosis

temperature > 39 °C

severe anaemia

complications

188
Q

Treatment of Severe falciparum malaria

A

parasite counts of more than2%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
Q

Malaria: investigation

A

thrombocythaemia is characteristic

normochromic normocytic anaemia

normal white cell count

reticulocytosis

Blood film

190
Q

The mostcommon cause of non-falciparum malaria is

A

Plasmodium vivax

191
Q

Plasmodium vivax/ovale: cyclical fever every ….Hrs

A

48 hrs

192
Q

Plasmodium malariae: cyclical fever every …..hrs

A

72 hrs

193
Q

Plasmodium malariae: is associated with

A

with nephrotic syndrome

194
Q

patients with ovale or vivax malaria should be given

A

primaquine following acute treatment with chloroquine to destroy liver hypnozoites and prevent relapse

195
Q

malarial prophylaxis in pregnancy

A

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
Q

Syphilis is caused by

A

spirochaete Treponema pallidum.

197
Q

Primary Syphilis features

A

chancre-painless ulcerat the site of sexual contact

local non-tender lymphadenopathy

198
Q

Secondary Syphilis features - occurs 6-10 weeks after primary infection

A

fevers, lymphadenopathy

rash on trunk, palms and soles

buccal ‘snail track’ ulcers(30%)

condylomata lata(painless, warty lesions on the genitalia )

199
Q

Tertiary syphilis features

A

granulomatous lesions of the skin and bones)

ascending aortic aneurysms

general paralysis of the insane

tabes dorsalis

Argyll-Robertson pupil

200
Q

Features of congenital syphilis

A

deafness

saddle nose

keratitis

rhagades (linear scars at the angle of the mouth)

blunted upper incisor teeth (Hutchinson’s teeth),’mulberry’ molars

201
Q

7 Causes of false positive non-treponemal (cardiolipin) tests:

A
  1. anti-phospholipid syndrome
  2. SLE
  3. pregnancy
  4. TB
  5. Leprosy
  6. malaria
  7. HIV
202
Q

Positive non-treponemal test + positive treponemal test

A

consistent with active syphilis infection

203
Q

Positive non-treponemal test + negative treponemal test

A

consistent with a false-positive syphilis result e.g. due to pregnancy or SLE

204
Q

Negative non-treponemal test + positive treponemal test:

A

consistent with successfully treated syphilis

205
Q

Syphilis: management

A

IM benzathine penicillin is the first-line management

alternatives: doxycycline

206
Q

causes of genital ulcers

A

Behcet’s disease

carcinoma

granuloma inguinale:Klebsiella granulomatis*

Lymphogranuloma venereum (LGV) is caused byChlamydia trachomatis

Chancroid is a tropical disease caused byHaemophilus ducreyi ( painful genital ulcers)

Syphilis is caused by Treponema pallidum ( painless ulcer )

Genital herpes ( multiple painful ulcers)

207
Q

Schistosoma haematobium is a risk factor for………….. cancer.

A

squamous cell bladder cancer.

208
Q

Schistosoma mansoni and Schistosoma japonicum can lead to

A

can lead to progressive hepatomegaly and splenomegaly due to portal vein congestion.

209
Q

Treatment of schistosomiasis ( bilharzia)

A

single oral dose of praziquantel

210
Q

Bactericidal antibiotics

A
  1. penicillins
  2. cephalosporins
  3. aminoglycosides
  4. quinolones
  5. nitrofurantoin
  6. metronidazole
  7. rifampicin
  8. isoniazid
211
Q

Bacteriostatic antibiotics

A
  1. macrolides
  2. chloramphenicol
  3. tetracyclines
  4. sulphonamides
  5. trimethoprim
  • MCTST
212
Q

Antibiotics Inhibit RNA synthesis

A

rifampicin

213
Q

Antibiotics Inhibit DNA synthesis

A

quinolones (e.g. ciprofloxacin)

metronidazole

sulphonamides

trimethoprim

214
Q

Antibiotics Inhibit protein synthesis

A

aminoglycosides (cause misreading of mRNA)

chloramphenicol

macrolides

tetracyclines

fusidic acid

215
Q

organisms are Gram-negative rods

A

Escherichia coli

Haemophilus influenzae

Pseudomonas aeruginosa

Salmonella sp.

Shigella sp.

Campylobacter jejuni

216
Q

Gram-positive rods (bacilli)

A
  • mnemonic = ABCD L

Actinomyces

Bacillus anthracis(anthrax)

Clostridium

Diphtheria:Corynebacterium diphtheriae

Listeria monocytogenes

217
Q

Gram-negative cocci

A

Neisseria meningitidis+Neisseria gonorrhoeae, alsoMoraxella catarrhalis

218
Q

3 Adverse effects of co-trimoxazole

A

hyperkalaemia

headache

rash (including Steven-Johnson Syndrome)

219
Q

Trimethoprim is like methotrexate which inhibits….

A

inhibits dihydrofolate reductase

220
Q

Adverse effects of Trimethoprim

A

myelosuppression

221
Q

4 adverse effects of tetracyclines

A

discolouration of teeth

photosensitivity

angioedema

black hairy tongue

222
Q

Tetracyclines should not be given to women who are pregnant orbreastfeedingdue to the risk of

A

discolouration of the infant’s teeth.

223
Q

disulfiram-like reaction with alcohol

Side effect of which antibiotic ?

A

Metronidazole

224
Q

5 Contraindications of BCG vaccine

A

previous BCG vaccination

a past history of tuberculosis

HIV

pregnancy

positive tuberculin test (Heaf or Mantoux)

225
Q

DNA viruses

A
  1. Herpesviruses
  2. HBV
  3. Adenovirus
  4. Parvovirus
  5. Papillomavirus
  6. Poxvirus
  7. Polyomavirus

*2HA4Py

226
Q

Examples of toxoid vaccines

A

tetanus

diphtheria

pertussis

227
Q

Examples of Live attenuated

A

BCG

measles, mumps, rubella (MMR)

influenza (intranasal)

oral rotavirus

oral polio

yellow fever

oral typhoid

228
Q

Examples of Inactivated preparations vaccines

A

rabies

hepatitis A

influenza (intramuscular)

229
Q

Examples of Subunit and conjugate vaccines

A

pneumococcus(conjugate)

haemophilus(conjugate)

meningococcus(conjugate)

hepatitis B

human papillomavirus

230
Q

Examples of Messenger RNA (mRNA) vaccines

A

COVID-19 vaccines

231
Q

Patient has had a full course of tetanus vaccines, with the last dose < 10 years ago

A

no vaccine nor tetanus immunoglobulin is required, regardless of the wound severity

232
Q

Patient has had a full course of tetanus vaccines, with the last dose > 10 years ago

A
  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
Q

If tetnus vaccination history is incomplete or unknown

A

reinforcing dose of vaccine, regardless of the wound severity

for tetanus prone and high-risk wounds: reinforcing dose of vaccine + tetanus immunoglobulin

234
Q

Treatment of strongyloidiasis

A

ivermectin and albendazole are used

235
Q

The strongest risk factor of Melioidosis, also called Whitmore’s disease

A

DM

236
Q

Pubic lice are caused by…..1…..

  1. Treatment
A
  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
Q

CMV retinitis is common, affecting patients who have a CD4 count <

A

50

238
Q

Fundoscopy

characteristic appearance showing retinal haemorrhages and necrosis

often called ‘pizza’ retina

Seen in

A

CMV retinitis

239
Q

Treatment of CMV retinitis

A
  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
Q

4 Factors which reduce vertical transmission of HIV

A

maternal antiretroviral therapy

mode of delivery (caesarean section)

neonatal antiretroviral therapy

infant feeding (bottle feeding)

241
Q

Mode of delivery in HIV

A

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
Q

Neonatal antiretroviral therapy

A

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
Q

3 Vaccines that can be used if CD4 > 200

A

MMR
Varicella
Yellow fever

244
Q

Vaccines are Contraindicated in HIV-infected adults

A

Cholera CVD103-HgR

Influenza-intranasal

Poliomyelitis-oral (OPV)

Tuberculosis (BCG)

245
Q

4 Possible causes of diarrhea in HIV patients

A

Cryptosporidium + other protozoa (most common)

Cytomegalovirus

Mycobacterium avium intracellulare

Giardia

246
Q

Treatment of diarrhea caused by Mycobacterium avium intracellulare in HIV patients

A

rifabutin, ethambutol and clarithromycin

247
Q

Immune reconstitution inflammatory syndrome is a condition generally associated with …

A

with HIV/immunosuppression,

248
Q

Which test is useful for diagnosis of neonatal HIV infection and screening blood donors

A

HIV RNA (qualitative or quantitative)

249
Q

all patients with aCD4 count < 200/mm³should receive……. prophylaxis

A

Pneumocystis cariniipneumonia (PCP)

250
Q

What is the most common complication of Pneumocystis cariniipneumonia ?

A

Pneumothorax

251
Q

Treatment of Pneumocystis cariniipneumonia

A

co-trimoxazole

IV pentamidine in severe cases

aerosolized pentamidine is an alternative treatment forPneumocystis jirovecipneumonia 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
Q

infections that may be encountered by patients with HIV according to the CD4 count < 50

A
  1. CMV retinitis
  2. Mycobacterium avium-intracellulare
  • cyto myco
253
Q

4 infections that may be encountered by patients with HIV according to the CD4 count 50 - 100

A

1.Cryptococcal meningitis
2. Oesophageal candidiasis
3. Primary CNS lymphoma
4. Aspergillosis

  • COLA
254
Q

4 infections that may be encountered by patients with HIV according to the CD4 count 200 - 500

A
  1. Shingles
  2. Hairy leukoplakia
  3. Oral thrush
  4. Kaposi sarcoma

*SHOK

255
Q

Treatment of Toxoplasmosis

A

sulfadiazine and pyrimethamine

256
Q

Treatment of PrimaryCNS lymphoma

A
  1. steroids
  2. chemotherapy (e.g. methotrexate) + with or without whole brain irradiation.
  3. Surgical may be considered for lower grade tumours
257
Q

India ink test positive In …..?

A

Cryptococcus

258
Q

Progressive multifocal leukoencephalopathy due to infection by ….

A

JC virus

259
Q

ritonavir: a potent inhibitor of

A

the P450 system

260
Q

What is The most common organism found in central line infections

A

Staph. Epidermidis

261
Q

Live attenuated vaccination

A

BCG
MMR
Influenza intranasal
Yellow fever

Oral rotavirus
Oral polio
Oral typhoid

MRCP Part 1 (17 decks)

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