Infectious Diseases Flashcards
1
Q
What are the live attenuated vaccines?
A
- BCG
- MMR
- Oral polio
- Yellow fever
- Oral typhoid
2
Q
Describe the clinical presentation of dengue fever
A
Retro-orbital headache, fever, facial flushing, rash, thrombocytopenia in returning traveller
3
Q
What is the most likely organism causing diarrhoea in a patient with HIV?
A
Cryptosporidium parvum
4
Q
Describe the presentation of Campylobacter infection
A
- Prodrome, abdominal pain and bloody diarrhoea
- Incubation period 1-6 days
5
Q
Name the first line antibiotic to treat MRSA
A
Vancomycin
6
Q
What is the treatment fo TB?
A
- Rifampicin, isoniazid, pyrazinamide and ethambutol for two months
- Continuation phase with rifampicin and isoniazid for an additional four months
7
Q
Name the second line antibiotic to treat MRSA
A
Linezolid
8
Q
What is the most common organism causing LRTI in CF patients?
A
Pseudomonas aeruginosa
9
Q
How does Giardia cause lactose intolerance?
A
Decreases the expression of brush-border enzymes in the small intestines
10
Q
A
11
Q
A
12
Q
Describe the clinical presentation of typhoid
A
- Initially systemic upset
- Relative bradycardia
- Abdominal pain, distension
constipation: although Salmonella is a recognised cause of diarrhoea, constipation is more common in typhoid - Rose spots: present on the trunk in 40% of patients, and are more common in paratyphoid
13
Q
What is the causative organism for typhoid?
A
Salmonella typhi
14
Q
Patients with cellulitis who are penicillin allergic can be given what?
A
Clarithromycin, erythromycin (in pregnancy) or doxycyline
15
Q
A 35-year-old man who is known to have advanced HIV disease presents with dysphagia and odynophagia. What is the most likely cause of his problems?
A
Oesophageal candidiasis
16
Q
A 15-week pregnant woman contacts her GP for advice because her 6-year-old son has recently been diagnosed with erythema infectiosum. She is clinically well and is immune to rubella. The GP arranges serology for parvovirus B19, which reveals parvovirus IgM positive and IgG negative.
What would be the most appropriate management?
A
Refer to fetal medicine for further tests
Bloods show a recent infection with parvovirus
17
Q
Describe the transmmission of hepatitis E
A
Hepatitis E is spread by the faecal-oral route and is most commonly spread by undercooked pork
18
Q
For a patient undergoing an elective splenectomy, when is the optimal time to give the pneumococcal vaccine?
A
Two weeks before surgery
19
Q
Describe the management of genital warts
A
- Multiple, non-keratinised warts: topical podophyllum
- Solitary, keratinised warts: cryotherapy
20
Q
Describe the presentation of disseminated gonococcal infection
A
Tenosynovitis, migratory polyarthritis, dermatitis
21
Q
Name a risk factor for nvasive aspergillosis
A
Leading cause of death in immunocompromised patients
22
Q
What are some of the causes of a false negative Mantoux test
A
- Immunosuppression - miliaryTB, AIDS, long-term steroid use
- Lymphoma
- Sarcoidosis
- Extremes of age
- Fever
- Hypoalbuminaemia
- Anaemia
23
Q
A 23-year-old woman presents with a two month history of cough and intermittent fever.
What is the most likely diagnosis?
A
TB
24
Q
What is the antibiotic of choice for cellulitis in pregnancy if the patient is penicillin allergic?
A
Erythromycin
25
What is the first line treatment in amoebiasis?
Metronidazole
26
Patient has had 5 doses of tetanus vaccine, with the last dose < 10 years ago.
Which of the following actions should be taken with regards to tetanus?
Don't require a booster vaccine nor immunoglobulins, regardless of how severe the wound is
27
Following an occupational exposure (sharps or mucosal splash) from an index case known to be HIV positive with an unknown or detectable HIV viral load, what duration of PEP is recommended?
Give 4 weeks of antiretroviral therapy and arrange HIV testing at 12 weeks
28
First line treatment for syphilis
Benzathine benzylpenicillin
29
True or false: a history of rash with penicillin is not a contraindication to using benzylpenicillin or ceftriaxone in meningococcal sepsis?
True
30
What blood results are associated with trimethoprim?
Can cause tubular dysfunction, leading to hyperkalaemia and increased serum creatinine
31
Severe hepatitis in a pregnant woman.
What is the most likely diagnosis?
Hepatitis E
32
What are the most common causes of viral meningitis in adults?
Enteroviruses
33
What is the management of pneumocystis jiroveci penumonia?
Co-trimoxazole, which is a mix of trimethoprim and sulfamethoxazole
34
What are the standard tests for HIV screening?
Combination tests (HIV p24 antigen and HIV antibody)
35
What are the contraindications for IV dex in meningitis?
* Meningococcal septicaemia (a non-blanching purpuric rash)
* Septic shock
* Recently out of surgery
* Immunocompromised
36
What are the features of secondary syphilis?
* 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 )
37
What are the features of tertiary syphilis?
* Gummas (granulomatous lesions of the skin and bones)
* Ascending aortic aneurysms
* General paralysis of the insane
tabes dorsalis
* Argyll-Robertson pupil
38
What serology is associated with successful treatment of syphilis?
TPHA remains positive, VDRL becomes negative
39
Pneumonia caused by what organism is associated with cold sores?
Streptococcus pneumoniae
40
Describe the presentation of parvovirus B19 (fifth disease)
* Fever
* Slapped cheek rash
* In patients with a background of haemolytic anaemia, particularly sickle cell disease - aplastic anaemia
41
Describe the presentation of CNS lymphoma
HIV, neuro symptoms, single brain lesions with homogenous enhancement
42
What organism causes BV?
Gardnerella vaginalis
43
How do you diagnose cellulitis?
Can be diagnosed clinically in primary care - offer oral antibiotics (fluclox first line)
44
Whais oral hairy leukoplakia?
EBV infections in HIV patients can cause oral hairy leukoplakia, which presents with white patches on the tongue, usually on the lateral borders
45
True or false: AFB smear is specific for TB
False - all mycobacteria will stain positive (e.g Mycobacterium leprae - leprosy)
46
What is the management for cellulitis near the nose or eyes?
Co-amoxiclav
47
Describe the presentation of yellow fever
Yellow fever typically presents with flu like illness → brief remission→ followed by jaundice and haematemesis
48
When should testing for HIV in asymptomatic patients should be done after possible exposure?
4 weeks
49
What is the management of suspected bacterial meningitis in patients < 50 years?
IV cefotaxime (or ceftriaxone)
50
What is the management of suspected bacterial meningitis in patients > 50 years?
Cefotaxime (or ceftriaxone) + amoxicillin
51
A 29-year-old woman develops severe vomiting four hours after having lunch at a local restaurant. What is the most likely causative organism?
Staph. aureus
52
A history of Intravenous drug use coupled with a descending paralysis, diplopia and bulbar palsy is characteristic of infection with what organism?
Clostridium botulinum
53
What strains of HPV cause genital warts?
HPV 6 & 11
54
How many doses of tetanus vaccine generally confers life-long protection?
5 doses
55
Which virus is thought to be the cause of Kaposi's sarcoma?
HHV-8 (human herpes virus 8)
56
What is the treatment of Legionella?
Macrolides such as clarithromycin
57
A 52-year-old female has very bad sunburn after only being outside for a very short period of time. What antibiotic is most likely to have caused this?
Doxycycline
58
What investigation would be used to diagnose TB in a patient with HIV?
Sputum culture
## Footnote
HIV significantly decreases the sensitivity of sputum smear for TB
59
What is the latest time that HIV post-exposure prophylaxis may be given?
72 hours after the event
60
What is the management of a patient in the last trimester of pregnancy who is diagnosed with a primary herpes infection?
Oral aciclovir 400 mg TDS (three times daily) until delivery
61
What CSF results are associated with TB meningitis?
* Appearance: slightly cloudy, fibrin web
* Glucose: Low (< 1/2 plasma)
* Protein: High (> 1 g/l)
* WCC: 30 - 300 lymphocytes/mm³
* Opening pressure: slightly raised
62
Describe the presentation of leptospirosis
* Early phase is due to bacteraemia and lasts around a week - fever, flu-like symptoms, subconjunctival suffusion (redness)/haemorrhage
* Second immune phase may lead to more severe disease (Weil's disease) - acute kidney injury, hepatitis,
aseptic meningitis
63
What drugs are used as prophylaxis for contacts of patients with meningococcal meningitis?
Oral ciprofloxacin or rifampicin
64
A 29-year-old man presents with a 12 day history of watery diarrhoea that developed one week after returning from India. He had travelled around northern India for two months. On examination he is apyrexial and his abdomen is soft and non-tender. What is the most likely causative organism?
Giardia lamblia
65
What is the most appropriate test to check for latent tuberculosis?
Mantoux (skin) test
66
A prison GP is bitten by a patient who is known to have hepatitis B. The GP has a documented full history of hepatitis B vaccination and was known to be a responder. What is the most appropriate action to reduce the chance of contracting hepatitis B?
Give a hepatitis B vaccine booster
67
A 48 year old farmer attends the emergency department 7 days after cutting his arm from falling on barbed wire in his field. You suspect tetanus and he tells you he has completed a course of tetanus vaccination previously.
What is the most appropriate treatment?
IM tetanus Ig
68
What is the most appropriate first-line treatment for gonorrhoea?
Intramuscular ceftriaxone
69
Intramuscular ceftriaxone
Nasal mupirocin + chlorhexidine for the skin
70
What CSF results are associated with viral meningitis?
* Appearance: clear/cloudy
* Glucose: 60-80% of plasma glucose
* Protein: Normal/raised
* WCC: 15 - 1,000 lymphocytes/mm³
* Opening pressure: Normal
71
What advice regarding work should be given to patients with latent TB?
People with latent tuberculosis cannot pass the disease on to others, so there is no restriction in terms of employment
72
What organism is associated with rose spots on the abdomen?
Salmonella typhi
73
Patient 6 days post-op in hospital develops pneumonia. What is the most appropriate management option?
Piperacillin with tazobactam
74
Do you need a CT/lumbar puncture before treating meningococcal meningitis?
No - start antibiotics immediately
75
Syphilis test results: treatment given, RPR has increased by at least 4x since diagnosis.
What is the next step?
Retreat with benzathine penicillin
## Footnote
Likely to be reinfected with syphilis from the sexual encounter(s) they have had since diagnosis
76
What is the most common complication of mumps in post-pubertal males?
Orchitis
77
Decribe the presentation of infectious mononucleosis
Young adult with sore throat, fever, lethargy, cervical lymphadenopathy persisting > 1 week
78
Decribe the management of infectious mononucleosis
Conservative - rest, hydration, simple analgesia
79
Patient presenting with bloody diarrhoea two months following a trip to Ghana.
What is the most likely diagnosis?
Amoebiasis
80
What is is the commonest cause of viral encephalitis in the adult population?
Herpes simplex virus
81
A 33-year-old woman with no past medical history of note is 28 weeks pregnant.
What vaccination should be offered?
Whooping cough (pertussis) vaccine
## Footnote
Pregnant women are advised to have a whooping cough (pertussis) vaccine between weeks 16 and 32 to protect their baby from developing whooping cough in the first few weeks of life
82
A 30-year-old who is currently 27 weeks pregnant comes to see you about a thin, white discharge. Swabs are taken and clue cells are seen on microscopy. Which treatment do you initiate?
Metronidazole 400mg bd for 7 days
83
True or false: you do not need to sent a test of cure for pregnant women treated for a UTI
False
84
What are the management options for chlamydia in pregnancy?
Azithromycin, erythromycin or amoxicillin
85
Name two conditions associated with a pH > 4.5
Trichomonas vaginalis + bacterial vaginosis
86
Syphilis result: TPHA positive, RPR negative.
What does this mean?
Successfully treated syphilis
87
A phlebotomist gives herself a needlestick injury whilst taking blood from a patient who is known to be hepatitis B positive. The phlebotomist has just started her job and is in the process of being immunised for hepatitis B but has only had one dose to date. What is the most appropriate action to minimise her risk of contracting hepatitis B from the needle?
Give an accelerated course of the hepatitis B vaccine + hepatitis B immune globulin
88
What is the management of schistosomiasis?
Praziquantel
89
What is the most appropriate management of asymptomatic BV?
No treatment required
## Footnote
Women with asymptomatic bacterial vaginosis do not usually require treatment unless they are undergoing termination of pregnancy
90
What is Lemierre's syndrome?
Thrombophlebitis of the internal jugular vein following an anaerobic oropharngeal infection
91
What is the most sensitive investigation for TB?
Sputum culture
92
Describe the presentation of cholera?
Diarrhoea and hypoglycaemia
93
What is the second line treatment for BV?
Topical clindamycin
## Footnote
Alternative to metronidazole for patients with bacterial vaginosis
94
What is the first-line test for HIV screening of asymptomatic individuals or patients with signs and symptoms of chronic infection?
Combined HIV antibody/antigen tests
## Footnote
HIV-1/2 Ab/Ag Immunoassay (fourth generation)
95
Describe the clinical presentation of yellow fever
* Classic description involves sudden onset of high fever, rigors, nausea & vomiting
* Bradycardia may develop. A brief remission is followed by jaundice, haematemesis, oliguria
96
Describe the presentation of hepatitis A
Flu-like symptoms, RUQ pain, tender hepatomegaly and deranged LFTs
97
Describe the clinical presentation of legionella
* Flu-like symptoms including fever
* Dry cough
* Relative bradycardia
* Confusion
* Lymphopaenia
* Hyponatraemia
* Deranged liver function tests
98
What is the investigation for legionella?
Urinary antigen
99
What diagnosis should be considered in the presentation of dysentery after a long incubation period?
Amoebiasis
100
What diagnosis should you consider in severe hepatitis in a pregnant woman?
Hepatitis E
101
What is the most common cause of travellers' diarrhoea?
Escherichia coli
102
What is the treatment for malaria?
Chloroquine + primaquine
103
What is the management of a UTI in a pregnant woman in the third trimester?
Amoxicillin or cefalexin
104
What is the management of botulism?
Supportive care and botulism antitoxin
105
What is the most common organism found in central line infections?
Staphylococcus epidermidis
106
What is the gold standard investigation for symptomatic schistosomiasis?
Urine or stool microscopy looking for eggs
107
Describe the presentation of lymphogranuloma venereum
Painless genital pustule → ulcer → painful inguinal lymphadenopathy → proctocolitis
108
What affect does parvovirus B19 infection during pregnancy have on the baby?
Fetal hydrops
## Footnote
Polyhydramnios, ascites and fetal skin oedema
109
How would you manage Campylobacter infection?
Often self-limiting but if severe then treatment with clarithromycin may be indicated
110
Describe the presentation of Chancroid
* Unilateral, painful inguinal lymph node enlargement
* The ulcers typically have a sharply defined, ragged, undermined border.
111
What is the causative organism of chancroid?
Haemophilus ducreyi
112
What is the most appropriate antibiotic to treat uncomplicated Chlamydia infection in a 21-year-old female who is not pregnant?
Doxycycline
113
Meningitis - evaluation of cerebrospinal fluid obtained by lumbar puncture reveals encapsulated organisms visible by India ink
What is the most likely causative organism?
Cryptococcus neoformans
114
What is the incubation period of Ebola virus?
2-21 days
115
Second line treatment for gonorrhoea if patient refuses IM ceftriaxone?
Combination of oral cefixime + oral azithromycin
116
What are the management options for severe cellulitis?
Co-amoxiclav, cefuroxime, clindamycin or ceftriaxone
117
Negative non-treponemal test + positive treponemal test is consistent with?
Successfully treated syphilis
118
What organisms can cause post splenectomy sepsis?
* Streptococcus pneumoniae
* Haemophilus influenzae
* Meningococci
119
What is the investigation for mycoplasma?
Serology
120
HIV, neuro symptoms, single brain lesions with homogenous enhancement
What is the diagnosis?
CNS lymphoma
121
What are the contraindications for LP in suspected bacterial meningitis?
Should not be done if there signs of severe sepsis or a rapidly evolving rash
122
What is the most likely infective agent for bacterial meningitis in patients 6 years - 60 years?
Streptococcus pneumoniae
123
What is the treatment of invasive diarrhoea (causing bloody diarrhoea and fever)?
Ciprofloxacin
124
What class of antibiotics can lead to black hairy tongue?
Tetracyclines
125
What is the most appropriate organism a for UTI in a breastfeeding woman?
Cefaclor
Trimethoprim if penicillin allergic
126
What is the most common causative organism for bronchiectasis exacerbations?
Haemophilus influenzae
127
What is the most common causative organism for CAP?
Streptococcus pneumoniae
128
True or false: immunocompetent patients with toxoplasmosis don't usually require treatment
True
129
What is the MOA of ritonavir?
Protease inhibitors
130
Chronic hepatitis B patients with acute flare up. What diagnosis should you consider?
Hepatitis D superinfection
131
What is the diagnostic test for Lyme disease?
Antibody titres for Borrelia burgdorferi
132
What are the most common causes of viral meningitis in adults?
Enteroviruses e..g coxsackievirus
133
Pneumonia + cavitating lesion.
What organism should you consider?
Staphylococcus aureus
134
A 55-year-old business man presents with a 15 day history of watery, non-bloody diarrhoea associated with anorexia and abdominal bloating. His symptoms started 4 days after returning from a trip to Pakistan. On examination he is apyrexial with dry mucous membranes but normal skin turgor. What is the most likely causative organism?
Giardiasis
135
Name a cause of pneumonia that can cause immune-mediated neurological diseases
Mycoplasma
136
Overgrowth of what organism causes bacterial vaginosis?
Gardnerella vaginalis
137
Name the organism:
* Gram-negative rod
* Non-lactose fermenting
* Oxidase positive
Pseudomonas aeruginosa
138
All patients with a CD4 count lower than 200/mm3 should receive what drug as prophylaxis against Pneumocystis jiroveci pneumonia?
Co-trimoxazole (trimethoprim with sulfamethoxazole)
