Infectious diseases

Question 1

Risk factors for C diff

Answer 1

Clindamycin, cephalosporins, co-amox, PPIs

Question 2

C diff management

Answer 2

First line - oral vancomycin
Second line - oral fidaxomicin
Third line - oral vancomycin +/- IV metronidazole

Question 3

Recurrent C diff management

Answer 3

Within 12 weeks of symptom resolution - oral fidaxomicin
After 12 weeks of symptom resolution - oral vancomycin OR fidaxomicin

Question 4

Lyme disease management

Answer 4

Early Lyme - 14-21 day course of doxycycline (or amox if contraindicated)
Disseminated disease - ceftriaxone

Question 5

Lyme disease presentation

Answer 5

Early features (within 30 days)
- Erythema migrans - painless bullseye rash at site of tick bite
- Systemic features - headache, lethargy, fever, arthralgia

Later features (after 30 days)
- CV - heart block, peri/myocarditis
- Neuro - facial nerve palsy, radicular pain, meningitis

Question 6

Lyme disease diagnosis

Answer 6

If erythema migrans present can be diagnosed clinically
Enzyme linked immunosorbent assay (ELISA) antibodies to Borrelia burgdorferi - may need to be repeated after 4-6 weeks if negative and tested within 4 weeks of symptom onset
Immunoblot test if positive ELISA or still suspected in people with symptoms >12 weeks

Question 7

HIV exposure management

Answer 7

PEP ASAP up to 72h after exposure for 4 weeks
HIV test at 12 weeks after completion of PEP

Question 8

Hep B exposure management

Answer 8

Booster of HBV vaccine if they are a known responder
HBIG and booster vaccine if they are a non-responder

Question 9

Hep C exposure management

Answer 9

Monthly PCR - if seroconversion then interferon +/- ribavirin