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MBChB Finals > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

What are the live attenuated vaccines?

A
  • BCG
  • MMR
  • Oral polio
  • Yellow fever
  • Oral typhoid
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2
Q

Describe the clinical presentation of dengue fever

A

Retro-orbital headache, fever, facial flushing, rash, thrombocytopenia in returning traveller

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3
Q

What is the most likely organism causing diarrhoea in a patient with HIV?

A

Cryptosporidium parvum

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4
Q

Describe the presentation of Campylobacter infection

A
  • Prodrome, abdominal pain and bloody diarrhoea
  • Incubation period 1-6 days
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5
Q

Name the first line antibiotic to treat MRSA

A

Vancomycin

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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
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7
Q

Name the second line antibiotic to treat MRSA

A

Linezolid

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8
Q

What is the most common organism causing LRTI in CF patients?

A

Pseudomonas aeruginosa

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9
Q

How does Giardia cause lactose intolerance?

A

Decreases the expression of brush-border enzymes in the small intestines

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10
Q
A
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11
Q
A
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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
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13
Q

What is the causative organism for typhoid?

A

Salmonella typhi

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14
Q

Patients with cellulitis who are penicillin allergic can be given what?

A

Clarithromycin, erythromycin (in pregnancy) or doxycyline

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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

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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

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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

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18
Q

For a patient undergoing an elective splenectomy, when is the optimal time to give the pneumococcal vaccine?

A

Two weeks before surgery

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19
Q

Describe the management of genital warts

A
  • Multiple, non-keratinised warts: topical podophyllum
  • Solitary, keratinised warts: cryotherapy
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20
Q

Describe the presentation of disseminated gonococcal infection

A

Tenosynovitis, migratory polyarthritis, dermatitis

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21
Q

Name a risk factor for nvasive aspergillosis

A

Leading cause of death in immunocompromised patients

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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
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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

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24
Q

What is the antibiotic of choice for cellulitis in pregnancy if the patient is penicillin allergic?

A

Erythromycin

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25
Q

What is the first line treatment in amoebiasis?

A

Metronidazole

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26
Q

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?

A

Don’t require a booster vaccine nor immunoglobulins, regardless of how severe the wound is

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27
Q

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?

A

Give 4 weeks of antiretroviral therapy and arrange HIV testing at 12 weeks

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28
Q

First line treatment for syphilis

A

Benzathine benzylpenicillin

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29
Q

True or false: a history of rash with penicillin is not a contraindication to using benzylpenicillin or ceftriaxone in meningococcal sepsis?

A

True

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30
Q

What blood results are associated with trimethoprim?

A

Can cause tubular dysfunction, leading to hyperkalaemia and increased serum creatinine

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31
Q

Severe hepatitis in a pregnant woman.

What is the most likely diagnosis?

A

Hepatitis E

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32
Q

What are the most common causes of viral meningitis in adults?

A

Enteroviruses

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33
Q

What is the management of pneumocystis jiroveci penumonia?

A

Co-trimoxazole, which is a mix of trimethoprim and sulfamethoxazole

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34
Q

What are the standard tests for HIV screening?

A

Combination tests (HIV p24 antigen and HIV antibody)

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35
Q

What are the contraindications for IV dex in meningitis?

A
  • Meningococcal septicaemia (a non-blanching purpuric rash)
  • Septic shock
  • Recently out of surgery
  • Immunocompromised
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36
Q

What are the features of secondary syphilis?

A
  • 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 )
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37
Q

What are the features of tertiary syphilis?

A
  • Gummas (granulomatous lesions of the skin and bones)
  • Ascending aortic aneurysms
  • General paralysis of the insane
    tabes dorsalis
  • Argyll-Robertson pupil
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38
Q

What serology is associated with successful treatment of syphilis?

A

TPHA remains positive, VDRL becomes negative

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39
Q

Pneumonia caused by what organism is associated with cold sores?

A

Streptococcus pneumoniae

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40
Q

Describe the presentation of parvovirus B19 (fifth disease)

A
  • Fever
  • Slapped cheek rash
  • In patients with a background of haemolytic anaemia, particularly sickle cell disease - aplastic anaemia
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41
Q

Describe the presentation of CNS lymphoma

A

HIV, neuro symptoms, single brain lesions with homogenous enhancement

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42
Q

What organism causes BV?

A

Gardnerella vaginalis

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43
Q

How do you diagnose cellulitis?

A

Can be diagnosed clinically in primary care - offer oral antibiotics (fluclox first line)

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44
Q

Whais oral hairy leukoplakia?

A

EBV infections in HIV patients can cause oral hairy leukoplakia, which presents with white patches on the tongue, usually on the lateral borders

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45
Q

True or false: AFB smear is specific for TB

A

False - all mycobacteria will stain positive (e.g Mycobacterium leprae - leprosy)

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46
Q

What is the management for cellulitis near the nose or eyes?

A

Co-amoxiclav

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47
Q

Describe the presentation of yellow fever

A

Yellow fever typically presents with flu like illness → brief remission→ followed by jaundice and haematemesis

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48
Q

When should testing for HIV in asymptomatic patients should be done after possible exposure?

A

4 weeks

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49
Q

What is the management of suspected bacterial meningitis in patients < 50 years?

A

IV cefotaxime (or ceftriaxone)

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50
Q

What is the management of suspected bacterial meningitis in patients > 50 years?

A

Cefotaxime (or ceftriaxone) + amoxicillin

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51
Q

A 29-year-old woman develops severe vomiting four hours after having lunch at a local restaurant. What is the most likely causative organism?

A

Staph. aureus

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52
Q

A history of Intravenous drug use coupled with a descending paralysis, diplopia and bulbar palsy is characteristic of infection with what organism?

A

Clostridium botulinum

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53
Q

What strains of HPV cause genital warts?

A

HPV 6 & 11

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54
Q

How many doses of tetanus vaccine generally confers life-long protection?

A

5 doses

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55
Q

Which virus is thought to be the cause of Kaposi’s sarcoma?

A

HHV-8 (human herpes virus 8)

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56
Q

What is the treatment of Legionella?

A

Macrolides such as clarithromycin

57
Q

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?

A

Doxycycline

58
Q

What investigation would be used to diagnose TB in a patient with HIV?

A

Sputum culture

HIV significantly decreases the sensitivity of sputum smear for TB

59
Q

What is the latest time that HIV post-exposure prophylaxis may be given?

A

72 hours after the event

60
Q

What is the management of a patient in the last trimester of pregnancy who is diagnosed with a primary herpes infection?

A

Oral aciclovir 400 mg TDS (three times daily) until delivery

61
Q

What CSF results are associated with TB meningitis?

A
  • 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
Q

Describe the presentation of leptospirosis

A
  • 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
Q

What drugs are used as prophylaxis for contacts of patients with meningococcal meningitis?

A

Oral ciprofloxacin or rifampicin

64
Q

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?

A

Giardia lamblia

65
Q

What is the most appropriate test to check for latent tuberculosis?

A

Mantoux (skin) test

66
Q

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?

A

Give a hepatitis B vaccine booster

67
Q

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?

A

IM tetanus Ig

68
Q

What is the most appropriate first-line treatment for gonorrhoea?

A

Intramuscular ceftriaxone

69
Q

Intramuscular ceftriaxone

A

Nasal mupirocin + chlorhexidine for the skin

70
Q

What CSF results are associated with viral meningitis?

A
  • Appearance: clear/cloudy
  • Glucose: 60-80% of plasma glucose
  • Protein: Normal/raised
  • WCC: 15 - 1,000 lymphocytes/mm³
  • Opening pressure: Normal
71
Q

What advice regarding work should be given to patients with latent TB?

A

People with latent tuberculosis cannot pass the disease on to others, so there is no restriction in terms of employment

72
Q

What organism is associated with rose spots on the abdomen?

A

Salmonella typhi

73
Q

Patient 6 days post-op in hospital develops pneumonia. What is the most appropriate management option?

A

Piperacillin with tazobactam

74
Q

Do you need a CT/lumbar puncture before treating meningococcal meningitis?

A

No - start antibiotics immediately

75
Q

Syphilis test results: treatment given, RPR has increased by at least 4x since diagnosis.

What is the next step?

A

Retreat with benzathine penicillin

Likely to be reinfected with syphilis from the sexual encounter(s) they have had since diagnosis

76
Q

What is the most common complication of mumps in post-pubertal males?

77
Q

Decribe the presentation of infectious mononucleosis

A

Young adult with sore throat, fever, lethargy, cervical lymphadenopathy persisting > 1 week

78
Q

Decribe the management of infectious mononucleosis

A

Conservative - rest, hydration, simple analgesia

79
Q

Patient presenting with bloody diarrhoea two months following a trip to Ghana.

What is the most likely diagnosis?

A

Amoebiasis

80
Q

What is is the commonest cause of viral encephalitis in the adult population?

A

Herpes simplex virus

81
Q

A 33-year-old woman with no past medical history of note is 28 weeks pregnant.

What vaccination should be offered?

A

Whooping cough (pertussis) vaccine

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
Q

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?

A

Metronidazole 400mg bd for 7 days

83
Q

True or false: you do not need to sent a test of cure for pregnant women treated for a UTI

84
Q

What are the management options for chlamydia in pregnancy?

A

Azithromycin, erythromycin or amoxicillin

85
Q

Name two conditions associated with a pH > 4.5

A

Trichomonas vaginalis + bacterial vaginosis

86
Q

Syphilis result: TPHA positive, RPR negative.

What does this mean?

A

Successfully treated syphilis

87
Q

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?

A

Give an accelerated course of the hepatitis B vaccine + hepatitis B immune globulin

88
Q

What is the management of schistosomiasis?

A

Praziquantel

89
Q

What is the most appropriate management of asymptomatic BV?

A

No treatment required

Women with asymptomatic bacterial vaginosis do not usually require treatment unless they are undergoing termination of pregnancy

90
Q

What is Lemierre’s syndrome?

A

Thrombophlebitis of the internal jugular vein following an anaerobic oropharngeal infection

91
Q

What is the most sensitive investigation for TB?

A

Sputum culture

92
Q

Describe the presentation of cholera?

A

Diarrhoea and hypoglycaemia

93
Q

What is the second line treatment for BV?

A

Topical clindamycin

Alternative to metronidazole for patients with bacterial vaginosis

94
Q

What is the first-line test for HIV screening of asymptomatic individuals or patients with signs and symptoms of chronic infection?

A

Combined HIV antibody/antigen tests

HIV-1/2 Ab/Ag Immunoassay (fourth generation)

95
Q

Describe the clinical presentation of yellow fever

A
  • Classic description involves sudden onset of high fever, rigors, nausea & vomiting
  • Bradycardia may develop. A brief remission is followed by jaundice, haematemesis, oliguria
96
Q

Describe the presentation of hepatitis A

A

Flu-like symptoms, RUQ pain, tender hepatomegaly and deranged LFTs

97
Q

Describe the clinical presentation of legionella

A
  • Flu-like symptoms including fever
  • Dry cough
  • Relative bradycardia
  • Confusion
  • Lymphopaenia
  • Hyponatraemia
  • Deranged liver function tests
98
Q

What is the investigation for legionella?

A

Urinary antigen

99
Q

What diagnosis should be considered in the presentation of dysentery after a long incubation period?

A

Amoebiasis

100
Q

What diagnosis should you consider in severe hepatitis in a pregnant woman?

A

Hepatitis E

101
Q

What is the most common cause of travellers’ diarrhoea?

A

Escherichia coli

102
Q

What is the treatment for malaria?

A

Chloroquine + primaquine

103
Q

What is the management of a UTI in a pregnant woman in the third trimester?

A

Amoxicillin or cefalexin

104
Q

What is the management of botulism?

A

Supportive care and botulism antitoxin

105
Q

What is the most common organism found in central line infections?

A

Staphylococcus epidermidis

106
Q

What is the gold standard investigation for symptomatic schistosomiasis?

A

Urine or stool microscopy looking for eggs

107
Q

Describe the presentation of lymphogranuloma venereum

A

Painless genital pustule → ulcer → painful inguinal lymphadenopathy → proctocolitis

108
Q

What affect does parvovirus B19 infection during pregnancy have on the baby?

A

Fetal hydrops

Polyhydramnios, ascites and fetal skin oedema

109
Q

How would you manage Campylobacter infection?

A

Often self-limiting but if severe then treatment with clarithromycin may be indicated

110
Q

Describe the presentation of Chancroid

A
  • Unilateral, painful inguinal lymph node enlargement
  • The ulcers typically have a sharply defined, ragged, undermined border.
111
Q

What is the causative organism of chancroid?

A

Haemophilus ducreyi

112
Q

What is the most appropriate antibiotic to treat uncomplicated Chlamydia infection in a 21-year-old female who is not pregnant?

A

Doxycycline

113
Q

Meningitis - evaluation of cerebrospinal fluid obtained by lumbar puncture reveals encapsulated organisms visible by India ink

What is the most likely causative organism?

A

Cryptococcus neoformans

114
Q

What is the incubation period of Ebola virus?

115
Q

Second line treatment for gonorrhoea if patient refuses IM ceftriaxone?

A

Combination of oral cefixime + oral azithromycin

116
Q

What are the management options for severe cellulitis?

A

Co-amoxiclav, cefuroxime, clindamycin or ceftriaxone

117
Q

Negative non-treponemal test + positive treponemal test is consistent with?

A

Successfully treated syphilis

118
Q

What organisms can cause post splenectomy sepsis?

A
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Meningococci
119
Q

What is the investigation for mycoplasma?

120
Q

HIV, neuro symptoms, single brain lesions with homogenous enhancement

What is the diagnosis?

A

CNS lymphoma

121
Q

What are the contraindications for LP in suspected bacterial meningitis?

A

Should not be done if there signs of severe sepsis or a rapidly evolving rash

122
Q

What is the most likely infective agent for bacterial meningitis in patients 6 years - 60 years?

A

Streptococcus pneumoniae

123
Q

What is the treatment of invasive diarrhoea (causing bloody diarrhoea and fever)?

A

Ciprofloxacin

124
Q

What class of antibiotics can lead to black hairy tongue?

A

Tetracyclines

125
Q

What is the most appropriate organism a for UTI in a breastfeeding woman?

A

Cefaclor

Trimethoprim if penicillin allergic

126
Q

What is the most common causative organism for bronchiectasis exacerbations?

A

Haemophilus influenzae

127
Q

What is the most common causative organism for CAP?

A

Streptococcus pneumoniae

128
Q

True or false: immunocompetent patients with toxoplasmosis don’t usually require treatment

129
Q

What is the MOA of ritonavir?

A

Protease inhibitors

130
Q

Chronic hepatitis B patients with acute flare up. What diagnosis should you consider?

A

Hepatitis D superinfection

131
Q

What is the diagnostic test for Lyme disease?

A

Antibody titres for Borrelia burgdorferi

132
Q

What are the most common causes of viral meningitis in adults?

A

Enteroviruses e..g coxsackievirus

133
Q

Pneumonia + cavitating lesion.

What organism should you consider?

A

Staphylococcus aureus

134
Q

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?

A

Giardiasis

135
Q

Name a cause of pneumonia that can cause immune-mediated neurological diseases

A

Mycoplasma

136
Q

Overgrowth of what organism causes bacterial vaginosis?

A

Gardnerella vaginalis

137
Q

Name the organism:

  • Gram-negative rod
  • Non-lactose fermenting
  • Oxidase positive
A

Pseudomonas aeruginosa

138
Q

All patients with a CD4 count lower than 200/mm3 should receive what drug as prophylaxis against Pneumocystis jiroveci pneumonia?

A

Co-trimoxazole (trimethoprim with sulfamethoxazole)

MBChB Finals (18 decks)

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