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FOCP > Infectious diseases > Flashcards

Infectious diseases Flashcards

1
Q

What is cellulitis?

A

Nonnecrotizing inflammation of the skin and subcutaeous tissue

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2
Q

What usually precedes cellulitis?

A

Breach in the skin

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3
Q

What are the signs and symptoms of cellulitis?

A

Erythema,pain, swelling, warmth

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4
Q

What is the most likely cause of a skin infection without underlying drainage, penetrating trauma, eschar or abscess?

A

Strep, Staph A, MrSA

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5
Q

What does skin infection with violaceous colour and bulae suggest in terms of causing pathogen?

A

Bibrio vulnificus, strep pneumoniae

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6
Q

What signs suggest severe infection in cellulitis?

A

Malaise, chills, fever, toxicity, lymphangitic spread, circumferetntial cellulitis, pain disproportionate to exam findings

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7
Q

What is lymphangitic spread?

A

Red lines streaking away from the area of infection

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8
Q

What are the indications for surgical evaluation in cellulitis?

A

Rapid progression, hypotension, violasceous bullae, skin sloughing, skin anaesthesia, cutaneous haemorrhage, gas in the tissue

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9
Q

What are the indications for a blood culture in a case of cellulitis?

A

Moderate to severe disease, cellulitis of specific anatomic sights, history of contact with contaminated water, animal bites, immunodeficiency

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10
Q

How should cellulitis with signs of systemic toxicity be investigated?

A

Blood culture, fbc, U and Es, CRP, creatinine, bicarb, creatine phosphokinase

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11
Q

When shoould needle aspiraiton be used in patients with cellulitis?

A

Bullae, diabetes, immunocompromise, neutropenic, not responding to therapy, animal bites

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12
Q

What is the most common cause of nonpurulent cellulitis?

A

Strep

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13
Q

What is the most common cause of purulent cellulitis?

A

S. A

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14
Q

What host factors predispose the host to severe infection due to cellulitis?

A

Lymphatic obstruction, DM, immunodeficiency, venous stasis, chronic liverdisease, venous stasis, peripheral arterial diseasechronic kidney disease

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15
Q

What can immunocompromised hosts be infected with that cause cellulitis?

A

Pseudomonas, proteus, serratia, Enterobacter, citrobactor, anaerobes, helicobacter cinaedi, fusarium

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16
Q

What are the hospital acquired forms of cellilitis?

A

beta haemolytic streptococcus, clostrididium perfringens,acinebacter baumannii, group A strep,

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17
Q

How can varicella affect cellulitis

A

Complicate

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18
Q

How ca cellulitis with varicella be identified?

A

Larger margins of erythema surroundings cvesicles

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19
Q

What can cause cellulitis with animal bites?

A

Capnoctophaga canimorsus (dog), Eikenella corrodens (human), Pasteurella corrodens (hdog/cat) streptobacillus moniliformis (rat)

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20
Q

What are the signs and symptoms of bacterial gastroentritis?

A

Diarrhoea, vomiting, fever, abdo pain, ingestion of particular food, exposure to water, travel, animals, dehydration, malnutrition, borborygmi, perianal erythema

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21
Q

How are diagnosis of gastroentritis made?

A

Presence or absence of symptoms, stool pH, stool culture, presence of pseudomembranes in the stool, faecal leukocytes, reducing substances, antisteriolysin O, selective culture to identify cause

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22
Q

What does the presenc3e of pseudomembranes in the stool suggest?

A

C. Diff

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23
Q

What is the management of bacterial gastroentritis

A

Since diarrhoea is mostly self limiting, oral rehydration, IV rehydation. monitoring for complication

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24
Q

What are the top three causes of bacterial gastroentritis world wide?

A

Salmonella, shigella, campylobacter

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25
Q

What are the characteristics of small bowel diarrhoea?

A

Watery, large volumes with increased frequency, pH<5.5, can have reding substances

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26
Q

What can cause small bowel diarrhoea?

A

Bacillus, s A, E coli, cholera, vibrio, listeria, C. perfringens,rota virus, adenovirus, astrovirus, calicivirus, norwalk virus, giardia, cryptosporidium

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27
Q

What are the characteristics of large bowel diarrhoea

A

Mucus and bloody, small volume with incresed frequency, pH>5.5, leukcytes present

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28
Q

What is the mechanism that causes small bowel diarrhoea?

A

Preformed toxins

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29
Q

What agents can cause large bowel diarrhoea?

A

e coli, shigella, salmonella, campylobacter, yersinia, aeromonas, plesiomonas, c difficile, entamoeba

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30
Q

Patient has had no incubation, sickness lasts 0-2 weeks, can have vomiting, fever, no abdopain, scuba diver, ate seafood, meat, vegetables, recently travelled, or went to mexico

A

Aeromonas

Associated with marine contact

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31
Q

Patient has incubation of 2-4 days, sickness lasts 5-7 days, fever, abdopain, ate uncooked dairy, poultry, meat. tenesmus.

A

Campylobacter

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32
Q

Patient has incubation of 1-16 hours, sickness lasts 1-2 days, vomiting, abdopain, eaten fried rice

A

Bacillus

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33
Q

Patient has had variable incubation, sickness is variable, mild fever and abdo pain, was hospitalized for pneumonia. Anorexic, malaise, crampy abdo pain, mild to moderate watery diarrhoea

A

C. diff

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34
Q

Patient has had 0-1 day incubation, sickness lasts 1 day, can have mild vomiting,abdopain, eating meat, vegetables, travelled to the tropics

A

C. perfringes

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35
Q

Patient has had 1-8 days incubation, sickness lasts 3-6 days, can have some fever, abdopain, eaten ground beef, alfaalfa sprouts

A

Enterohaemorrhagic e coli

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36
Q

Patient has had 1-3 days incubation, sickness lasts 3-5 days, can have vomiting, low fever, abdopain, recently travelled

A

Enterotoxic e coli

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37
Q

Patient has had 20 hours incubation, sickness lasts 2 days, can have some vomiting, fever, some abdopain, eaten diary

A

Listeria

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38
Q

Patient has had no incubation, sickness lasts 0-2 weeks, can have some vomiting, fever, abdopain, recently travelled to mexico, has liver cancer

A

Plesiomonas

Associated with liver probs or malignancy

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39
Q

Patient has had 0-3 days incubation, sickness lasts 2-7 days , can have vomiting, fever, abdopain, eaten dairy, eggs, meats, alphaalpha sprouts, recently travelled

A

Salmonella

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40
Q

Patient has had 0-2 days incubation, sickness lasts 2-7, high fever, abdopain, competitive swimmer, bloody diarrhoea, passage of mucus, crampy abdo pain, tenesmus

A

Shigella

associated with swimming pools

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41
Q

Patient has had 2-6 hours incubation, sickness lasts 1 day, can have vomiting, abdopain,

A

S A

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42
Q

Patient has had 0-1 day incubation, sickness lasts 5-7 days, can have vomiting, abdopain, eaten seafood, recently travelled to africa, asia

A

Vibrio

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43
Q

Patient has had 1-6 days incubation, sickness lasts 1-46 days, can have vomiting, fever,abdopain, eaten chicken, travelled to Australia, canada, europe or mexico

A

Y enterocolitis

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44
Q

How does viral gastroentritis typically spread?

A

Faecal oral route through contamniated food and water, can be through airborne route

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45
Q

How does rotavirus cause diarrhoea?

A

Causes maldigestion of carbs, and carb accumulation, secretes enterotoxin

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46
Q

What is the typical presentation of viral gastroentritis?

A

Short prodrome, mild fever, vomiting, 1-4 days of nonbloody, watery diarrhea, usually self limited

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47
Q

What are the warning sign of a bacterial gastroentritis?

A

Increased frequency, bloody diarrhoea, high fever, severe abdo pain, travel, sexual practice, antibiotic use

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48
Q

What should be done during the examination of a patient with diarrhoea

A

Assess hydration

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49
Q

What are the causes of infantile viral gastroentritis?

A

Group A rotavirus, astrovirus, calicivirus, adenovirus, sapovirus, norovirus

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50
Q

What are the causes of epidemic viral gastroentritis?

A

Norovirus, sapovirus, rota virus, astrovirus

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51
Q

What are the causes of sporadic adult viral gastroentritis?

A

Calicivirus, rotavirus, astrovirus, adenovirus

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52
Q

what is the most common cause of community acquired inflammatory enteritis?

A

Campylobactor jejuni

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53
Q

What does diarrhoea, malaise, weakness, abdo distension, malodorous greasy stool, abdo cramps, flatulence, nausea, anorexia, weight loss, low grade fever and urticaria suggest?

A

Giardiasis

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54
Q

What are the signs and symptoms of viral nasopharyngitis?

A

Common cold. Literally this.

Nasal mucosal erythema (red nose), oedema (nose swelling), nasal discharge (profuse discharge), foul breath, fever

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55
Q

What suggests bacterial nasopharyngitis?

A

Nasal discharge becomes cloudy white, yellow or green over several days

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56
Q

What are the signs and symptoms of group A streptococcal pharyngitis

A

Tender cervical lymphnodes, exudates, swelling or tenderness of tonsils or harynx, temp>38.3, Absence of [Conjunctivitis, cough, rhinorrhea]

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57
Q

What are the signs and symptoms of acute bacterial rhinosinusitis in children

A

Persistent nasal discharge, cough > 10 days severe fever > 3 days, worsening cough

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58
Q

What are the signs and symptoms of epiglottitis?

A

Cherry red epiglottis, sore throat, drooling, difficulty/pain swallowing, muffled dysphonia, fever, fatigue, malaise, dry cough, dypnea, tripod posture

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59
Q

When is testing of nasopharyngeal specimen required?

A

Immunocompromise, when treatment is specific

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60
Q

What is the management of epiglottis?

A

Hospitalization, monitoring, O2, avoid instrumentation, IV antibiotics

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61
Q

What are the physical and mechanical barries to prevent URTIs

A

Hair lining, mucus, ciliated cells, humoral immunity, inflammtory cytokines

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62
Q

What are the more common causes of nassopharyngitis?

A

Rhinoviruses, coronaviruses, enteroviruses, adenoviruses, orthomysoviruses, paramyxoviruses, RSV, EBV, human metapneumovirus, boca virus

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63
Q

What are the most common viral causes of pharyngitis?

A

Adenovirus, influenza, coxsackie, HSV, EBV, CMV

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64
Q

What are the most common bacterial causes of pharyngitis?

A

Group A strep, N. gonorrhea, anaerobes, diptheria, corynebacter

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65
Q

What are the viral causes of rhinosinovitis?

A

Adenovirus, enterovius, Enterovirus, RSV, whinovirus, coronavirus, influenza

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66
Q

What are the bacterial causes of rhinosinivitis?

A

Strep. pneumoniae, H. influ. B, SA, mooraxella

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67
Q

What are the bacterial causes for laryngitis?

A

SA, strep pneumonia, Chlamydia, mycoplasma, morexella, diphteria, group A strep, TB

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68
Q

What are the viral causes of laryngitis?

A

Rhinovirus, coronavirus, RSV, adenovirus, influenza, parainfluenza

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69
Q

What are the RF for URTIs?

A

Contact, , anatomical cahnges, smokiing, travel, inflammation, immunocompromise

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70
Q

What are the complications of URTIs?

A

Otitis media, meningitis, bronghitis, brain abscess, sepsis, pneumonia

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71
Q

What is bacterial sepsis?

A

Symptomatic bacteraemia, with or without organ dysfunction

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72
Q

What are the signs and symptoms of bacterial sepsis?

A

Fever, impaired mental status, tachypnea, rigors, warm or cold skin, abdopain, abnormalities on rectal exam, gaurding, fatigue, malaise, nausea, vomiting

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73
Q

What can cause sepsis from the GI tract?

A

Liver disease, gallbladder disease, perforation, peritonitis, obstruction, colon disease

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74
Q

What can cause sepsis from the GU tract?

A

Pyelonephritis, perineprhric abscess, renal calculi, obstruction, renal insufficiency, pelvic abscess

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75
Q

What can cause sepsis from LRTI?

A

Pneumonia, abscess, empyema

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76
Q

What can cause sepsis from the CV system?

A

Infected prosthetic, IV line, acute endocarditis, myocardial or perivalvular ring abscess

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77
Q

What tests are used to diagnose sepsis?

A

FBC, blood culture, urine studies, gram staining, ECG, CXR, US, CT, MRI

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78
Q

What are the sepsis 6?

A

Give: High flow O2, IV antibiotics, IV fluids
Take: blood, urine output, lactate levels

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79
Q

What is SIRS?

A

Systemis inflammatory response syndrome

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80
Q

What is the criteria for SIRS?

A 
Two or the following 
High fever (>8)
Tachycardia (>90)
Tachypnea (>20)
Raised or reduced WBC count
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81
Q

What organisms can cayse septic shock from LRTIs?

A

Strep. pneumoniae, klebsiella, legionella, E coli, SA, Haemophilus, pseudomoonas, anaerobes, gram -ve bacteria, fungi

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82
Q

What organisms can cause septic shock from GI infections?

A

Ecoli, enterococcus, salmonella, klebsiella, pseudomonas, bacteriodes fragilis, aceinebacter, enterobacter, anaerobes

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83
Q

What can cause septic shock from UTIs?

A

E coli, proteus, enterococcus, candida, klebsiella, serratia, enterobacter, serratia

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84
Q

What can cause septic shock from GTIs?

A

N. gonorrhea, gram -ve bacteria, streptococci, anaerobes

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85
Q

What can cause septic shock from soft tissue infections?

A

S A, strep epidermidis, fungi, gram -ve bacteria, streptococci, anaerobes, fungi

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86
Q

What can cause septic shock from foreign bodiea?

A

S A, s. epidermidis, fungi

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87
Q

What are the RF for sepsis?

A

Extremes of hair, underlying condition, immuno suppression, major surgery, prolonged hospital stay, generic susceptability, invaasive procedures, previous antibiotic treatment

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88
Q

What are the RF for early mortality with sepsis?

A

Curb 65, acute failure of 2 or more organ systems, low pH, shock

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89
Q

What are the complications of sepsis?

A

ARDS, AKI, DIC, chronic renal dysfuntion, mesenteric ischaemia, MI, liver failure`

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90
Q

What are the signs and symptoms of active pulmonary TB?

A

Cough, fever, night sweats chills, haemoptysis, fatigue, weight loss, anorexia, chest pain, Abnomal breath sounds, bronchial breath

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91
Q

Which group of people may not show trypical signs and symptoms of TB?

A

Elderly

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92
Q

What are the signs and symptoms of TB meningitis?

A

Persistent headache (2-3 weeks), mental status change, progressive deterioration, low grade or absent fever

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93
Q

What are the signs and symptoms of skeletal TB?

A

Back pain or stiffness, lower extremity paralysis, TB arthritis

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94
Q

What are the symptoms genitourinary TB?

A

Flank pain, dysuria, frequent urination, painful scrotal mass, prostatis, orchitis, epdidymitis, like PID

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95
Q

What are the symptoms of GI TB?

A

Malabsorption, pain, diarrhea, abdo pain like ppeptic ulcers, nonhealing ulcers of mouth and anus

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96
Q

How is TB diagnosed?

A

Mantoux tuberculin skin test, invitro blood test for mycobacterium TB antigens, acid-fast bacilli smear, HIV serology, blood culture, FBC, bedsides, CXR,

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97
Q

What are the signs seen due to TB on a CXR?

A

Cavity formation, non calcified round infiltrates, calcified nodules

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98
Q

What des primary TB look like on a CXR?

A

Pneumonia like

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99
Q

What does reactivation TB look like on a CXR

A

Previous pulmonary lesions

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100
Q

What does healed and latent TB look like on a CXR

A

Dense pulmonary nodules, , smaller nodues in upper lobes

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101
Q

What does TB with HIV look like on a CXR?

A

Frequently atypical lesions

Normal CXR

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102
Q

What does miliary TB look like on a CXR??

A

Numerous small, nodular lesions

Like mill seeds

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103
Q

What does pleural TB look like on a CXR?

A

Empyema, pleural effusion

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104
Q

How are patients with TB managed?

A

Isolation, high infection, 4 drug regimens, sensitivity of TB must be checked

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105
Q

What is infective endocarditis?

A

Infectionof endocardial or endothelial surface of the heart by any microorganism

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106
Q

What happens if infective endocarditis isn’t treated?

A

DEATH

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107
Q

What are the intracardiac effects of infective endocarditis?

A

Congestive HF, myocardial abscess, severe valvular insuffiency

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108
Q

What are the classic signs and symptoms of infective endocarditis?

A

FEVER, HEART MURMUR, Janeway lesions, oslers nodes, roth spots, petechia, splinter haemorrhage, strope, intracerebral haemorrhage, multiple microabscess in the brain, splenomegaly, stiff neck, delirium, pallor, gallops, pericardial/pleural rub, rales, cardiac arrhythmia,, rales, anorexia, non-specific signs

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109
Q

How can infective endocarditis be investigated?

A

Bedsides, ECG, FBC, echocardiogram, LFT, TFTs, echocardiogram,

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110
Q

How is infective endocarditis treated?

A

antibiotics (IV) 2-6 weeks

Surgery for debridement if valve doesn’t work

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111
Q

What are the types of infective endocarditis?

A

Native valve endocarditis, prosthetic valve endocarditis, IV drug abuse endocarditis

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112
Q

What is acute of native valve endocarditis?

A

Normal valves

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113
Q

What is acute native valve endocarditis progress?

A

Aggresive course

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114
Q

What does subacute native endocarditis usually effect?

A

Abnormal valves

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115
Q

What usually causes subacute native endocarditis?

A

Alpha-haemolytic streptococci, enterococci

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116
Q

What usually causes prosthetic valve endocarditis?

A

Coagulase-ve staphylococci, gram-ve bacilli, candida,staph, alpha-haemolytic streptococci and enterococci, staph A

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117
Q

Which is the most common place affected by infective endocarditis?

A

Mitral,

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118
Q

What is the pathophysiology of infective endocarditis?

A

Smooth muscle damage due to turbulent blood flow in the heart body creates platelet plug, Bacteremia, adhesion of organisms, invasion of valvular leaflets

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119
Q

How many blood cultures should be taken in a patient with query infective endocarditis?

A

Max three

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120
Q

What are the complications of endocarditis

A

Congestive HF, emboli, glomerulonephritis, abscess, stroke

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121
Q

What is the most common causative agent of infective endocarditis in IVDU?

A

Staph A

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122
Q

What is SIRS?

A

Systemic inflammatory response syndrome

Abnormal regulation of cytokines, endotoxins and acid metabolism

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123
Q

How are patients with suspected sepsis initially assessed?

A

ABCDE
History
Examination

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124
Q

What are the rf for sepsis?

A

Extremes of age, impaired immune sustem, given birth, termination, miscarriage in the last 6 weeks

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125
Q

How is sepsis recognised early?

A

NEWS, qSOFA

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126
Q

How is sepsis managed?

Buffaloes buffalo, Y’know?

A 
Bloods
Urine output
Fluids,
Antibiotics
Lactate
Oxygen
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127
Q

What are the complications of septic shocks

A

ARDS, encephalopathy, AKI, protein from liver

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128
Q

What is qSOFA.

A 
Quick sepsis related organ failure assessment
3 criteria,
Low Bp
Tachypnoea
Altered mental state (GCS<15)
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129
Q

What type of virus is Hep a?

A

Small, unenveloped, symmetrical RNA virus

Picornovirus

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130
Q

How does hep a spread

A

Faecal oral

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131
Q

What prevents the spread of infection of hep a

A

Hand washing and food and drink hygiene

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132
Q

What is the most important determinant of illness severity in hep a?

A

Age extremes

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133
Q

What are the rf for hep a?

A

Travellers, IVDU, immunocompromised, personal contact, occupation, anal sex with multiple partners, clothing factor disorders receiving factor VIII and IX.

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134
Q

What species are reservoirs for hep A

A

Humans

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135
Q

What is the incubation time of hep a?

A

2-6 weeks

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136
Q

Hat does viral replication depend on in hep a?

A

Uptake of hepatocytes

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137
Q

What does the onset of symptoms depend on in hep a?

A

Viral load

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138
Q

What is the life cycle of hep a?

A

Virus uptake into hepatocytes- virus un coats- host ribosomes bind to RNA- viral genome copied by viral RNa polymerase- assembled viruses shed through biliary tree to faeces

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139
Q

What is the most common type of viral hepatitis?

A

Hep a

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140
Q

Where are the high risk areas of hep a?

A

Indian subcontinent, Far East, central and South America, Middle East, Africa

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141
Q

When is hep a most infectious?

A

12-21 days post infection

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142
Q

What can be seee in the prodromal phase of hep a?

A

Flu like symptoms, anorexia, nausea, joint pain, malaise, fatigue, jaundice diarrhoea

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143
Q

What can be seen in hep a in a serious infection? Icteric phase

A

Dark urine, pale stools, jaundiced Abdo pain, itch, arthralgia, skin rash, tender Hepatomegaly, splenomegaly, lymphadenopathy

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144
Q

What are the differentials of hep a?

A

Other viral hepatitis, acute HIV, drugs, CMV

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145
Q

What can be used to investigate hep a?

A

IgM antibody and igG for hep a, LFTs, Fbc, bilirubin

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146
Q

What is the management of hep a?

A

Supportive, avoid alcohol

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147
Q

What are the complications of hep a?

A

Cholestatic hepatitis, fulminant hep, AKI, guillan barré, relapsing hep a

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148
Q

How is hep a prevented?

A

Vaccine

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149
Q

What is the most common cause of hepatitis?

A

Hep b

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150
Q

What is the incubation period of hep b?

A

40-160 days

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151
Q

What is the presentation of hep B?

A

Anorexia, nausea, ache in RUQ, mild fever, malaise, jaundice, darkening urine and lightening faeces

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152
Q

What is the presentation of de compensated liver disease caused by hep b?

A

Ascites, encephalopathy, GI haemorrhage

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153
Q

What is the definition of chronic hep b?

A

Spectrum of disease characterised by presence of detectable,hep b surface antigen in blood or serum for longer than six months

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154
Q

What is the route of transmission if hep b .

A

Parenteral
Via fluids or blood
Vertically

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155
Q

What general investigations should be done on query hep b?

A

Fbc, lft, bilirubin clotting, lipid profile, ferritin, antibody screen, caeruloplasmin,

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156
Q

What are the investigations specific to hep B?

A

HbsAg, HBeAg, anti-HBe, anti-HBs, anti-HB core.

Quantitative hep B virus DNA, HBV genotype, HDV serology

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157
Q

What is the treatment for chronic hep B?

A

Peginterferone Alfa-2a, tenor obit disoproxil as second line

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158
Q

What type of virus is hep C?

A

Enveloped RNA virus in flaviviridae familu

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159
Q

How does HCV spread?

A

Blood borne

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160
Q

What is the incubation period of HCV?

A

6-9 weeks

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161
Q

What are the rf of Hep C?

A

IVDU, blood transfusion, pregnancy and breast feeding, sex, needles tick, tattooing, shaving razors

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162
Q

What rfs are associated with more rapid disease progress in HCV?

A

Over forty, alCohol, male, co infection with hep b,, HIV

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163
Q

What is the presentation of acute HCV?

A

Anorexia, weakness, malaise, jaundice, deranged liver enzymes, abdopain,

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164
Q

How long does it take post infection for signs of HCV to appear?

A

6-7 weeks

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165
Q

What percentage of patients develop chronic HCV?

A

75%

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166
Q

What investigations can be used for HCV?

A

Anti-HCV, HCV RNA to confirm ongoing infection, LFTs,baseline us to look for lesions, liver biopsy, HIV testing, non invasive. MErasures to test fibrosis

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167
Q

What diseases are associated with HCV?

A

DM, sjorgen’s, cryoglobulinaemia, polyarthritis autoimmune hepatitis, thyroid it’s, glomerulonephritis, lichen planus, thrombocytopenia, Hepatocellular carcinoma

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168
Q

What is the drug treatment for HCV?

A

Weekly, sc injections of Peginterferone Alfa-2a and daily oral ribavirin

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169
Q

What type of virus is hep D?

A

Unusual, defective single stranded RNA virus, requires HBV to replicate

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170
Q

How does hep D sprad?

A

Bloodborne

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171
Q

What is the main reservoir of HEV?

A

Pigs

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172
Q

How is HEV transmitted?

A

Faecal oral,contaminated water

173
Q

What is the incubation period of HEV?

A

2-9 weeks

174
Q

How does HEV create a chronic infection?

A

It does not

175
Q

How is HEV prevented?

A

Good hand hygiene, avoid contaminated water

176
Q

what are the viral causes of hepatitis?

A

HAV, HBV, HCV, HDV, HEV, CMV, EBV, HSv, adenovirus

177
Q

WHat is the acute presentation of viral hepatitis?

A

Nausea, vomiting, myalgia, fatigue, malaise, RUQ, change in smell or taste, coryza, photophobia, headache, hepatosplenomegaly, lymphadenopathy, diarrhoea, pale stools dark urine, jaundice

178
Q

Which viruses are most likely to form chronic hepatitis infections>

A

HBV, HCV, HDV

179
Q

What are the non-infectious causes of acute hepatitis?

A

Drugs, toxins, alcohol

180
Q

What are the non-infectious causes of chronic hepatitis?

A

Drugs, alcohol, autoimmune hepatitis, haemochromatosis, wilson’s disease

181
Q

What is TB?

A

Chronic granulomatous disease caused by mycobacterium tb, m. bovis and m. africanum

182
Q

How is TB spread?

A

Inhalation of infected drops

183
Q

What is the pathophysiology of TB?

A

M. TB is encountered and engulfed by macrophages, carried into to hilar lymph nodes

184
Q

What is miliary TB?

A

Primary infection is not adequately contained, spreads to blood stream

185
Q

What is secondary TB?

A

Reactivation of semi-dormant TB

186
Q

What can cause the reactivation of TB?

A

Malnutrition, AIDs, immunosuppressive therapy

187
Q

Where does reactivation of TB usually occur?

A

Apex of lungs, can spread locally or to distant sites

188
Q

What are the RF of TB infection?

A

Homelessness, close contact with a TB patient, ethnic minorities, alcoholics, drug users, HIV patients, immunocompromise, elderly, children

189
Q

What is the definition of an uncomplicated UTI?

A

UTI in a patient with a normal urinary tract and kidney function

190
Q

What is the definition of an abnormal UTI?

A

anatomical, functional or pharmacological factors preispose a person to persistent or recurrent infection, or treatment failure

191
Q

What is a Lower UTI?

A

Cystitis

192
Q

What is an upper UTI?

A

pyelitis or pyleonephritis

193
Q

What are the common causes of UTIs in normal people?

A

Ecoli, staph saprophyticus, proteus, enterococci

194
Q

What are the causes of UTIs in patients with underlying pathology, frequent infections or immunocompromise?

A

Klebsiella, proteus vulgaris, candida, pseudomonas

195
Q

What are the RF for a UTI?

A

Instrumentation, incomplete emptying, antibiotics, new sex partner, spermicides, diabetes, catheter, anatomical abnormality, institutionalization, immunocompromise, pregnancy genetic

196
Q

What is the presentation of a UTI?

A

Urinary frequency, painful passing of small amountss of urine, dysuria, foul-smelling, cloudy urine, urgency, incontinence, pyrexia, rigoors, suprapubic or loin pain, nausea anf vomiting, confusion

197
Q

What are the differentials for a UTI?

A

Urethrl syndrome, atrophic vaginitis, GTIs, enlarged prostate

198
Q

What are the investigations for a UTI?

A

Dipstick, microscopy, culture, US, PSA if suspspicion of prostate cancer

199
Q

Who should be referred with UTI?

A

Persistently not responded to treatment, history of renal tract disease or anomaly, haematuria, recurrent infections

200
Q

What is the treatment of an uncomplicated UTI?

A

Trimethoprim or nitrofurantoino, fluids

201
Q

How long is the treatment for an complicated UTI in women?

A

3 days

202
Q

How long is the treatment of an uncomplicated UTI in men?

A

7 days

203
Q

What is the treatment for an uncomplicated pyelonephritis?

A

Ciprofloxacin for 7-10 days

204
Q

What are the complications of a UTI due to ascending infection?

A

Pyelonephritis, perinephric ad ubtrarenal abscess, hydronephrosisor pyonephritis, AKI, sepsis, prostatic abscess, prostatitis

205
Q

What are tge complications of an untreated bacteruria in pregnancy?

A

Pyelonephritis, prem, anaemia

206
Q

How is HIV diagnosed?

A

anti HIV antibodies in serum

207
Q

How is an acute HIV infection diagnosed?

A

presence of p24 antigen or HIV RNA by PCR, precedes appearance of IgM and IgA

208
Q

WHat is the combination test for HIV?

A

Screening of HIV antigen and p24. Takes 4 weeks

209
Q

What are the 5 stages of HIV infection?

A

Seroconversion illness, asymp infection, persistent genralized lymphadenopathy, symptomatic infection, AIDS

210
Q

When does a seroconversion illness occur?

A

1-6 weekspost-infection

211
Q

What are the symptoms of an HIV seroconversion illness?

A

Glandular-fever like, fever, malaise, myalgia, pharyngitis, headaches, diarrhoea, neuralgia, neuropathy lymphadenopathy, maculopapular rash

212
Q

What tests can be done in the seroconversion illness stage of HIV?

A

p24 and hIV RNA

213
Q

What is the definition of persistet generalised lymphadenopathy?

A

Nodes >1 cm at two estra inguinal sites persisting for three months or longer, not due to any other causes

214
Q

What investigations should be done for HIV?

A

detection of HIV antibody, assessment of viral load, FBC, EXR, signs of other infections, screening for STIs, CXR, cervical smear

215
Q

Why should FBC done for HIV?

A

anaemia, thrombocytopenia, lymphocytopenia, reduced CD4

216
Q

What is the CD4 staging technique for HIV?

A

CD4 > 500 cells/mm3 (29%)
CD4 200 - 500 cells/mm3 (14-28%)
CD4 < 200 cells/mm3 (14%)

217
Q

What are the aids defining illnesses (10)

A

Candadiasis, karposi’s sarcoma, TB, cervical carcinoma, CMV, encephalopathy, cryptosporidiasis, toxoplasmosis, histoplasmosis, recurrent pneumonia, lymphoma, burkitt’s, pneumocystitis jirovecii pneumonia, wasting syndrome

218
Q

How is HIV monitored?

A

clinical assessment, CD4 monitoring, plasma HIV RNA, clinical benefit from treatment

219
Q

How is HIV managed?

A

Antiretrovirals, prevention of getting aids defining illness, advice on the spread of infection

220
Q

What is dengue?

A

Mosquito borne viral haemorrhagic fever transmitted by female aedes mosquitos

221
Q

How is dengue classified?

A

Non-severe dengue (with or without warning signs), severe dengue

222
Q

What are the warning signs of dengue?

A

fever, nausea, vomiting, rash, aches, pains, positive tourniquet test, leukopenia, abdopain, persistent vomiting, fluid accumulation, mucosal bleeding, lethargy, liver enlargement, blood in vomit, bleeding gums, restlessness

223
Q

What are the signs of severe dengue?

A

severe plasma leakage, severe bleeding, organ failure, shock, res. distress,

224
Q

Where is dengue endemic too?

A

Africa, americas, eastern mediterranean, southest aia, western pacific

225
Q

What are the risk factors for contracting dengue?

A

High population density urban living, poor public hygiene exposure to mosquito

226
Q

What are the rf for developing severe dengue?

A

Age (under 15), repeated dengue infections, genetic F viral genotypes, nutritional status

227
Q

What is the incubation period of dengue?

A

2-7 days

228
Q

What causes haemorrhage in dengue?

A

severe thrombocytopenia

229
Q

What causes plasma leakage in dengue?

A

Proliferation of T cells and the production of cytokines

230
Q

What are the signs of capillary leak in dengue?

A

raised haematocrit, hypoalbuminaemia, pleural effsuions, ascites

231
Q

What are the symptoms of dengue?

A

Biphasic high fever, severe headache, pain behind the eyes, muscle and joint pain, nausea vomiting, rash, swollen glands

232
Q

What is the tourniquet test for dengue?

A

Inflating bp cough between systolic and diastolic bp, shows more than 20 petechiae per 2.5 cm2 are seen

233
Q

What are the signs of nonsevere dengue?

A

machular, blanging rash, tender muscles, +ve tourniquet test

234
Q

What are the signs of non-severe dengue with warning signs?

A

Haemorrhagi manifestations, purpura, gum bleeding, epistaxis, gi haaemorrhage, menorrhagia, hypotension, narrow pulse ressure, poor cap refill, relative bradycardia, hepatomegaly, lymphadenopathy

235
Q

What are the signs of severe dengue?

A

Pleural effusion, ascites, pericarditis, periorbital oedema, proteinuria, maculopathy, retinal haemorrhage, hypovolaemic shock, CNS involvement, hepatitis, myocarditis

236
Q

what investigations can be done for dengue?

A

FBC, clotting, U and Es, bicarbonate, IgM, IgG, PCR techniques, CXR, blood culture, malaria films, LFTs

237
Q

What does a FBC show in dengue?

A

high PCV, low platelets

238
Q

What does the clotting studies show in dengue?

A

prolonged APTT and PT

239
Q

What do U and Es and LFTs reveal in dengue?

A

electrolyte abnormalitis, raised LFTs

240
Q

What is the management of dengue?

A

fever control with paracetamol, sponging and fans, IV fluid resus, FFp and platelets, monitor CVP, urine output, electrolytes, packed cell volume, platelets, LFTs

241
Q

What is the prognosis of dengue?

A

Usually a self limiting illness

242
Q

What are the complications of dengue?

A

Hepatic failure, encephalopathy, myocarditis, disseminted IV coag septicaemia,

243
Q

how is dengue prevented?

A

Vaccine, removing stagant water sources, pesticides

244
Q

What is typhoid fever caused by?

A

Gram-ve salmonella enterica typhi from contaminated waters

245
Q

What causes paratyphoid fever?

A

S. paratyphi A, S. schottmuelleri, S. hirschfeldii

246
Q

What are the RF of typhoid?

A

reduction in stomach acidity, immunosuppression, other infections, haemoglobinapathies,

247
Q

What is the presentation of typhoid in week 1?

A

Gradual rise in temp, dry cough, relative bradycardia, malaise, headache, epistaxis, abdo pain, leukopenia, blood cultures,

248
Q

What is the presentation of typhoid in week 2?

A

toxic appearance with apathy and sustained pyrexia.
High fever around 40°C (104°F), often swinging.
Malaise and weakness.
Relative bradycardia, with dicrotic pulse wave.
Confusional state, which gave typhoid the name of ‘nervous fever’.
Rose spots on the lower chest and abdomen - seen in around one third of Caucasian patients; difficult to see in darker skin. Rose spots are caused by bacterial emboli. They are crops of macules 2-4 mm in diameter that blanch on pressure.
Lung base rhonchi.
Abdominal distension with right lower quadrant tenderness and increased borborygmi.
Diarrhoea, typically green, with a characteristic foul smell, often compared to pea soup.
Constipation may also occur.
Hepatosplenomegaly
Elevated liver transaminases.

249
Q

What is the presentation of typhoid in week 3?

A

considerable weight loss.
Pyrexia persists and a toxic confusional state may occur.
Marked abdominal distension develops and liquid, foul, green-yellow diarrhoea is common.
The patient is weak with a weak pulse and raised respiratory rate.
Crackles may develop over the lung bases.
Death can occur at this stage from overwhelming toxaemia, myocarditis, intestinal haemorrhage, or perforation of the gut, usually at Peyer’s patches.
Complications which are most likely to develop at this stage include:
Intestinal haemorrhage due to bleeding from congested Peyer’s patches.
Perforation of the distal ileum, frequently fatal. There may be little warning, and peritonitis is a common complication.
Encephalitis.
Neuropsychiatric symptoms: muttering, picking at clothes, confusion.
Metastatic abscesses.
Cholecystitis.
Endocarditis.
Osteitis.
Dehydration is a significant risk.
One third develop a macular truncal rash.
Thrombocytopenia with risk of bleeding.
Eye complications may occur

250
Q

What is the presentation of typhoid in week 4

A

In the untreated patient the fourth week sees the fever, mental state and abdominal distension slowly improve over a few days, but intestinal complications may still occur. Convalescence is prolonged, and most relapses occur at this stage.

251
Q

What are the symptoms of parathyroid fever?

A

Vague chills, sweating, headache, weakness, dry cough, anorexia, sore throat, dizziness, and muscle pains are frequently present before the onset of fever.
Rising then persistent fever.
Abdominal pain (in about a third of patients).
Relative bradycardia.
Hepatosplenomegaly.
Rose spots (in about a third of patients).
Constipation (more common than diarrhoea).
Very rarely, neuropsychiatric symptoms
Very rarely, epileptiform seizures

252
Q

What tests can be used to investigate typhoid fever?

A

Blood cultures, widal’s test

253
Q

How is typhoid fever managed?

A

Rapid diagnosis and institution of appropriate antibiotic treatment.
Adequate nutrition
Supportive
Antipyretic therapy
Hygiene
Regular follow-up and monitoring for complications and clinical relapse (
Antibiotics (see below) -
Steroids
Surgical - if perforation of the bowel occurs it will require closure.

254
Q

What antibiotics can be used for typhoid?

A

3rd generation of cephalosporin: cefotaxime, ciprofloxacin

255
Q

What are the complications of typhoid?

A

The two most common complications are haemorrhage (including disseminated intravascular coagulation) and perforation of the bowel. Before antibiotics, perforation had a mortality of around 75%.
Jaundice may be due to hepatitis, cholangitis, cholecystitis, or haemolysis.
Pancreatitis with acute kidney injury and hepatitis with hepatomegaly are rare.
Toxic myocarditis occurs in 1-5% of patients (ECG changes may be present). It is a significant cause of death in endemic areas.
Toxic confusional states and other neurological and psychiatric disturbances have been reported.

256
Q

What is the most frequent organism causing septic arthritis?

A

Staph A

257
Q

What are the risk factors for septic arthritis?

A

Increasing age, DM, prior joint damage, joint surgery, prosthetics, skin infection with prosthetics, immunodeficiency

258
Q

WHat is the classic picture of septic arthritis?

A

Fever, swollen joint, pain on active and passive movement, rigors, bacteremia

259
Q

What are the differentials for septic arthritis?

A

RA, osteoarthritis, vasculitis, gout, pseudogout, reactive arthritis, lymes

260
Q

What is the causes of septic polyarticular arthritis?

A

Staph A, Lyme’s, gonoccal disease, reactive A

261
Q

What causes infection of sternoclavicular and sacroiliac joints?

A

Group B strep

262
Q

What type of septic arthritis usually presents with fever, arthralgia, multiple skin lesions, tenosynovitis of hands, knees, wrists, ankles and elbows?

A

Gonoccal disease

263
Q

What causes Lyme’s disease?

A

Borrelia burgdorferi

264
Q

What can cause viral arthritis?

A

HIV, rubella, parvovirus, hep C

265
Q

What lab tests investigate septic arthritis?

A

CRP, FBC, ESR, lactate, synovial fluid exam and culturem blood culture if there is a fever, PCR, test for lymes

266
Q

What imaging should be done for septic arthritis?

A

X ray

267
Q

What signs would be seen in an x ray with septic arthritis?

A

fat pad displacement, swelling of capsule and soft tissuesm joint space narrowing

268
Q

How is septic arthritis treated?

A

Empirically to cover staph A and strep

269
Q

What is the recommended treatment for septic arthritis?

A

Fluclox for 4-6 weeks

270
Q

How is MRSA septic arthritis treated?

A

Vancomycin 4-6 weeks

271
Q

How is gonoccocal or gram -ve arthritis treated?

A

4-6 weeks

272
Q

What are the complications of septic arthritis?

A

Amputation, arthrodesis, prosthetic surgeerym severe functional deterioration

273
Q

What is Malaria?

A

Parasitic disease caused by infection of the genus plasmodiu

274
Q

Which species can cause malaria?

A

Falciparum, vivax, ovale, malaria

275
Q

WHat is the most common cause of malaria in England?

A

P. Falciparum

276
Q

What is the clinical features of P. falciparum?

A

Severe disease and malaria related deaths
Incubation of 7-14 days
swinging fever every 48-36 hours)

277
Q

What are the clinical features of P.Vivax?

A

Causes benign tertian malaria - fever every third day.
Incubation period of 12-17 days.
Relapse due to dormant parasites in the liver.

278
Q

What are the clinical features of P. ovale?

A

Relapsing course as with P. vivax.

Incubation period of 15-18 days.

279
Q

What are the RF of severe malaria?

A

Poor, extremes of age, pregnant, non-immune people

280
Q

What are the RFs of developing malaria?

A

Travels to area of humidity, temp 20-30, monsoon, ruralareas, accomodation, outside at dusk or dawn, longer trips

281
Q

What are the symptoms of malaria?

A 
Fever, often recurring
Chills
Rigors
Headache
Cough
Myalgia
Gastrointestinal upset
282
Q

What are the signs of malaria?

A 
Fever
Splenomegaly
Hepatomegaly
Jaundice
\+/- abdominal tenderness
283
Q

What are the signs of severe disease in malaria?

A 
Impaired consciousness.
Shortness of breath.
Bleeding.
Fits.
Hypovolaemia.
Hypoglycaemia.
Acute kidney injury.
Nephrotic syndrome.
Acute respiratory distress syndrome (during treatment).
284
Q

What are the investigations involved with Malaria?

A

Thick and thin blood smear
Rapid diagnostic tests, nucleic acid based tests
FBC, G6PD, LFTs
Uand E, ABG, Blood culture, clotting studies, urine and stool culture, CXR, lumbar

285
Q

What would LFTs and U and Es show in Malaria

A

LFTs - often abnormal.

U&Es - may show lowered Na+ and increased creatinine.

286
Q

What aould an FBC show in Malaria?

A

typically reveals thrombocytopenia and anaemia. Leukocytosis is rarely seen but is an indicator of a poor prognosis when present.

287
Q

What is the treatment of non-falciparum malaria?

A

Chloroquinine

prevention of relapse: primaquine

288
Q

What is the treatment of uncomplicated falciparum malaria?

A

Oral quinine sulfate 600 mg/8 hours for 5-7 days plus doxycycline 200 mg daily (or clindamycin 450 mg/8 hours for pregnant women) for seven days.
Atovaquone-proguanil (Malarone®): four standard tablets daily for three days.
Artemether with lumefantrine (Riamet®): if weight >35 kg, four tablets stat and then a further four tablets at 8, 24, 36, 48 and 60 hours.

289
Q

What is the treatment of severe or complicated falciparum malaria?

A

IV quinine dihydrochloride is the first-line antimalarial drug.
Oral quinine sulfate 600 mg tds
Artesunate regimen

290
Q

What are the complications of malaria?

A 
Impaired consciousness or seizures (cerebral malaria).
Renal impairment.
Acidosis.
Hypoglycaemia.
Pulmonary oedema or acute respiratory distress syndrome.
Anaemia.
Splenic rupture.
Disseminated intravascular coagulopathy.
Shock secondary to complicating bacteraemia/sepsis (algid malaria).
Haemoglobinuria ('black water fever').
Multiple organ failure.
Death.
291
Q

What are the methods of prevention of Malaria prophylaxis?

A

Use of effective chemoprophylaxis and insecticide-treated nets (ITNs) prevents about 90% of malaria.[7]Travellers should be encouraged to use a prophylactic regime appropriate to their travel itinerary
Be mosquito smart

292
Q

WHat is meningitis?

A

Inflammation of the leptomeninges and underlying subarachnoid CSF

293
Q

What are the RF of meningitis?

A

Spinal procedures, CSF shunts, renal insufficiency, DM, Infective endocarditis, hypoparathyroidism, adrenal insufficiency, thalassameia, crowding, immunosuppression

294
Q

What are the common causes of meningitis in neonates?

A

Group B strep, L. monocytogenes, E. coli

295
Q

What are the common causes of meningitis in onfants or younger children?

A

HiB, strep. pneumonia, N. meningitidis

296
Q

What are the causes of meningitis in adults and older children?

A

Strep pneumoniae, HiB, N. meningitidis, gram -ve bacteria, staph, strop, L. monocytogenes

297
Q

What are the common causes of meningitis in the elderly and immunocompromised>

A

S. pneumoniae, L. monoctytogenes, TB gram -ve

298
Q

What are the causes of hospital acquired and post traumatic meningitis?

A

SA, klebsiella pneumoniae, E. coli, pseudomonas aeruginosa

299
Q

What are the causes of aseptic meningitis?

A

Partly treated bacterial meningitis, viral infection, fungal infection, parasities, mollaret’s meningitis, kawaski’s

300
Q

What are the viral causes of meningitis?

A

HIV, HSV, measles, influenza arbovirus, coxsackie, echovirus, mumps, zoster

301
Q

What are the non-infective causes of meningeal irritation?

A

Malignancy, chemicals, drugs, sarcoidosis, SLE, behcets

302
Q

What is the clinical presentation of meningitis?

A

Fever, headache, stiff neck, altered mental status, shock,kernig and babinski’s sign, photophobia, menigoccal septicaemia - purpuric, non-blanching rash, seizures,

303
Q

What are the differentials of meningitis?

A

Intracranial abscess, other causes of fevers and rashes, encephalitis, subarach haemorrhage, brain tumours, encephalopathies

304
Q

What investigations should be done for meingitis?

A

FBC, serum glucose, Lumbar puncture, CRP, blood cutule, ABG, serology of blood, urine and CSF, test for syphilis, cryptococcal antigen, coag screen

305
Q

What is the management of viral meningitis?

A

Analgesia, antipyretics, nutritional support, hydration

306
Q

What is the manageent of bacterial meningitis?

A

Benzylpenicillin IM, IV ceftriaxime, fluids, antipyretics, corticosteroids

307
Q

What are the complications of meningitis?

A

Septic shock, disseminated IV coag, coma, cerebral oedema, raised ICP, seizures CN dysfunction, hydrocephalus, intellectual difficulties, ataxia, blindness

308
Q

What is the prevention of meningitis?

A

Vaccinations: hib, meningococcus B, C, strep/ pneumoniae

309
Q

What is encephalitis?

A

Inflammation of brain parenchyma?

310
Q

What are the viral causes of encephalitis?

A

HSV, CMV, adenovirus, HIV, toxoplasmosis, parvovirus B19, japanese encephalitis, equine encephalitis, arbovirus, polio, influenza, rubella rabies

311
Q

What are the bacterial causes of encephalitis?

A

TB, mycoplasma, listeria, lymes, cat scratch fever, lepospira. legionella, neurosyphilis

312
Q

What are the fungal causes of encephalitis?

A

Cryptococcosis, coccidiomyocosis, north american blastoyocosis, candidiasis

313
Q

What are the parasitis causes of encephalitis?

A

African trypanosomiasis, tocoplasmosis, echinococcus, schistosomiasis

314
Q

What is the presentation of encephalitis?

A

flu-like illness, headache, rapid development of altered consciousness, confusion, drowsiness, seizures, coma, ICP raised, photophobia, sensory changes, focal neurological signs, cognitive impairment

315
Q

What are the investigations needed for encephalitis?

A

FBC, blood culture, CRP, CSF LP, CT scan, EEG

316
Q

What is the management of encephalitis?

A

Urgent hospital admission, IV antibiotics, IV acyclovir,

317
Q

What are the complications of encephalitis?

A

DIC, inappropriate ADH secretion, cardiac, and resp distress, epilepsy, neuropsychiatric problems,

318
Q

What are warning signs in the presentation of the tropical traveller?

A

Jaundica, rash, paralysis, difficulty breathing, persistent vomiting, uncontrolled bleeding altered consciousness

319
Q

What conditions should be considered in a tropical traveller presenting with fever?

A

Malaria, hepatitis, typhoid, cholera, yellow fever, dengue, typhus, rocky mountain fever, rabies, plague, viral haemorrhagic feversbrucellosis, histoplasmosis

320
Q

What conditions should be considered in a tropical traveller presenting with respiratory problems?

A

TB, influenza, SARS

321
Q

What conditions should be considered in a tropical traveller presenting with lymphadenopathy?

A

Plague, HIV< rickettsial, brucellosis, leishmaniasis, dengue, lymphogranuloma, lassa fever

322
Q

What conditions should be considered in a tropical traveller presenting with jaundice?

A

Hepatitis, malaria, brucellosis, typhoid, yellow fever, dengue,

323
Q

What conditions should be considered in a tropical traveller presenting with hepatosplenomegaly?

A

Malaria hepatitis, typhoid, yellow fever, dengue, leishmaniasis, schistosomiasis, toxoplasmosis

324
Q

What conditions should be considered in a tropical traveller presenting with petechia and bruising?

A

Viral haemorhagic fever, dengue, yellow fever, meningococcal fever

325
Q

What are the STIs seen in tropical travellers?

A

HIV, chlamydia, HIV, syphilis,

326
Q

What happens in the infectious stage of typhoid?

A

Constipation

327
Q

What is the main cause of death due to typhoid?

A

Intestinal bleeding due to necrosis of intestine

328
Q

What is the incubation period of typhoid?

A

7-14 days

329
Q

What are the three types of bacteria with notable polysaccharide capsid that forms a noticed pathogenicity?

A

Hib, strep pneumonia, pseudomonas

330
Q

What does raised neutrophils suggest?

A

Bacterial infection

331
Q

What does raised lymphocytes suggest?

A

Viral infection

332
Q

What is osteomyelitis?

A

Inflammation of bone tissue

333
Q

What is pyogenic osteomyelitis?

A

Organisms cause pus

334
Q

What are the signs and symptoms of pneumonia?

A

Breathlessness, productive cough, green sputum, bronchial breathing, crepitations, dullness to percussion, reduced vocal resonance, fever, chills, myalgia

335
Q

What are the common causes of community aquired pneumonia?

A

Strep pneumonia, HiB, klebsiella, morazella

336
Q

What are the causes of atypical pneumonia?

A

Chlamydia, legionella, mycoplasma

337
Q

What are the causes of hospital acquired pneumonia?

A

SA, MRSA

338
Q

WHat investigations should be done for pneumonia?

A

Obs, ECG, sputum culture, throat swab, FBC, PCT, CRP, ESR, blood culture, Us and Es, LFTs, CXR

339
Q

What are the RF of pneumonia?

A

COPD, asthma, lung cancer, hospitalization age, immunoompromise, aspiration

340
Q

What is the CURB 65 score?

A

Measure of mortality fdue to pneumonia. Decision making aid on what antibiotics to use for a patient and whether the patient should be hospitalised

341
Q

What is the criteria for CURB65?

A 
one point for 
Confusion
Urea>7mmol/l
Resp>30
BP<90/60
Age>=65
342
Q

How mmany points need to be scored toon CURB65to nesscisate a hospital admission?

A

2 or more

343
Q

What are the complications of pneumonia?

A

Sepsis, lung abscess, death, pulmonary scarring, lobar collapse, pleural effusion

344
Q

What is cholecystitis?

A

Inflammation/infection of th cystic duct due to gallstones

345
Q

What are the risk factors of cholecystitis?

A

Fat, forty, fertile, female, fair, sudden weightloss, chron’s

346
Q

What are the signs and symptoms of cholecytitis?

A

RUQ pain, vomiting, fever, local peritonism, GB mass, Murphy’s sign

347
Q

What is murphy’s sign?

A

Cessation or holding of breath when two fingers are placed in the RUQ

348
Q

When is Murphy’s sign positive?

A

When the arrest of respiration is NOT seen on the left side

349
Q

What is the management of cholecytitis?

A

Analgesia, IV antibiotics, cholecystectomy

350
Q

What are the investigations of cholecystitis?

A

FBC, LFTs, US, hydroxyiminodiacetic acid

351
Q

What can be seen in the LFTs and FBCs in cholecystitis?

A

Raised WCC, slightlyderanged LFTs

352
Q

What can be seen in an US of cholecystitis

A

Gallstones, thickened gallbladdrr wall

353
Q

WHat is cholangitis?

A

Inflammation of the gallbladder

354
Q

Whar is charcot’s triad?

A

RUQ pain, fever, jaundice

355
Q

What does charcot’s triad show?

A

Cholangitis

356
Q

What are the causes of Cholangitis?

A

Iaschaemia, motility disorders, chemical injury, microorganisms

357
Q

what pathogens can cause cholangitis?

A

Klebsiella, enterococci, Streptococci, E. coli, Round worm enterobacter

358
Q

Whatis the presentatin of cholangitis?

A

Fever, RUQ pain, jaundice

Myalgia, malaise, lethargy, cnonfusion shock

359
Q

What can be used to investigate cholangitis?

A

OBs, FBC, CRP, blood cultures, LFTs, Us nd Es, ERCP, MRCP,

360
Q

What is the management of cholangitis?

A

Fluid resus, IV antibiotics,

361
Q

WHat are the complications of cholangitis?

A

Shock, Acute lung injury, AKI, Confusion, DC hepatic injury, liver abscess, liver failure

362
Q

What is the definition of a UTI?

A

Presence for a pure growth if more than 10^5 organisms in an MSU, and the patient is symptomatic

363
Q

Who is asymptomatic bacteria is treated in?

A

Pregnant women

Urology procedure patients with expected mucosal bleeding

364
Q

What can cause complicated UTIs?

A

Abnormal anatomy, abnormal renal function immunosuppression. Pregnancy

365
Q

Why is pregnancy a risk factor for a UTI?

A

Increased levels of progesterone increases reflux

366
Q

What are the rf of UTI?

A

Female, sex, stones, catheter, DM, decreased bladder emptying, pregnancy, elderly, hospitalization

367
Q

What are the symptoms of cystitis and urethritis?

A

Dysuria, increased frequency, fevers, haematuria, loin pain lower back ache,

368
Q

What are the symptoms of prostatitis?

A

Prodromal flu-like symptoms, lower back pain, perineal pain, not many urinary symptoms

369
Q

What is the presentation of pyelonephritis?

A

Loin to groin pain, rigors, fever, nausea, vomiting, oligouria with AKI

370
Q

What bug does not cause a raised nitrite in a urine dipstick?

A

Proteus

371
Q

What are the complications of UTI?

A

Sepsis, renal failure

372
Q

Risk factors for catheter associated UTIs

A

Frequency of changing catheter, aseptic technique, hygiene, female. Duration, bacteria in drainage bag, DM, older age, poor catheter care

373
Q

What are the common cause of catheter associated UTIs?

A

E. coli, enterococcus, pseudomonas, candida

374
Q

How is TB spread?

A

Airborne

375
Q

What causes TB?

A

mycobacterium TB, mycobacterium bovis, mycobacterium africanum

376
Q

What are the signs and symptoms of TB?

A

Dramatic weight loss, fever, night sweats, tiredness, fatigue, persistent cough. Coughing up blood

377
Q

What are the investigations if TB?

A

Sputum fir afbx3
CXR
IGR,
Bronnchial lavage

378
Q

What are TB sputum screened for?

A

Acid fast bacilli

379
Q

What causes more deaths, meningococcal septicaemia or meningitis?

A

Meningococcal septicaemia, because it tends to incubate longer

380
Q

Gram +ve diplococci

A

Strep pneumonia

381
Q

Gram -ve diplococci(bacilli)

A

Neisseria meningitidis

382
Q

What is the empirical treatment if meningitis/encephalitis

A

IV cefotaxime 2g qds

Ceftriaxone 2g bd

383
Q

What can be seen in latent TB in an x ray”

A

Calcifying lesion on apex of lung

Primary complex

384
Q

What tests can be used to diagnose latent TB.

A

Manitou, interferon gold

385
Q

What is the term for raised neutrophils?

A

Neutrophilia

386
Q

What are the causes of severe raised CRP?

A

Vasculitis, infection

387
Q

What is the likely causes of peri orbital cellulitis?

A

GAS, spreads faster

SA

388
Q

What is the antibiotic of choice for GAS?

A

Coamox

389
Q

What does a GAS Cause?

A

Cellulitis

390
Q

Which cause of endocarditis is more likely to cause enterococcus?

A

Enterococcus

391
Q

What are the side effects of gentamicin

A

Nephrotoxic, ototoxic

392
Q

Describe janeway lesions

A

Flat to skin, non tender, red

393
Q

Describe Roth slots

A

Emboli on the eye

394
Q

Describe Osler nodes,

A

Tips of fingers and toes, tender, immunological response, raised, white

395
Q

What can cause a rapid drop of polumorphonuclear leucocytes?

A

Chemo

396
Q

What are the key indicators of rf for neutropenia fever?

A

Chemo, long lines, steroids, immunosuppressants,

397
Q

What is the most common cause of a line infection?

A

Coag -ve staphylococcus

398
Q

What are the warning signs for immunocompromise

A

Recurrent ear infection, pneumonia, sinus, skin. Deep seated infection, poor response to antibiotics, antibiotics with little effect, faltering growth in child

399
Q

Describe C. difficile

A

Enterotoxin a and b
Faecal oral spread
Forms spores

400
Q

What is the typical clinical manifestation of C. difficile

A

Green watery diarrhoea, difficulty to control

401
Q

What are the worst complications of C. difficile

A

Pseudo membranous colitis,

Toxic mega colon

402
Q

Why does C. difficile cause diarrhoea?

A

Enterotoxins, physiological response to flush out toxins and pathogen

403
Q

What is the severe clinical manifestation of C. difficile

A

Abdo pain, cramps, peritonism, toxic patient, high frequency of green smelly watery diarrhoea

404
Q

How is c diff investigated

A

C diff specific gluteraldehylde de hydrogenated antigen, toxins a and b,
C. Diff culture, PCR

405
Q

What % of bacteria in the gut is anaerobic?

A

99%

406
Q

What are the stages of dengue?

A

Febrile
Leaky capillaries
Convalescent

407
Q

What is the presentation of bacterial conjunctivitis?

A

Purulent, sticky, crusty discharge, conjunctival redness, foreign body sensation, no acuity change, no photophobia

408
Q

What is a red flag for bacterial conjuctivitis

A

Bilateral conjunctivitis

N. Gonorrhoea

409
Q

What is the clinical presentation of viral conjunctivitis?

A

Bilateral watery discharge, redness in one eye followed by the second a few darts later

410
Q

What can cause viral conjunctivitis?

A

Adenovirus, hsv, vsv, molluscum

411
Q

What is the clinical picture of acanthamoeba?

A

Pain, redness, blurred vision, photophobia, excess tearing

Associated with corneal injury

412
Q

What is the clinical presentation if trachoma

A

Most common cause if preventable blindness
Chlamydia in the eye, conjuctivitis,
Scarring under eyelid

413
Q

What is the clinical picture of ophthalmia neonatrum

A

Neonatal conjunctivitis, orbital pain, purulent discharged conjunctival hyperaemia

414
Q

What are the stages of dengue?

A

Febrile
Leaky capillaries
Convalescent

415
Q

What is the presentation of bacterial conjunctivitis?

A

Purulent, sticky, crusty discharge, conjunctival redness, foreign body sensation, no acuity change, no photophobia

416
Q

What is a red flag for bacterial conjuctivitis

A

Bilateral conjunctivitis

N. Gonorrhoea

417
Q

What is the clinical presentation of viral conjunctivitis?

A

Bilateral watery discharge, redness in one eye followed by the second a few darts later

418
Q

What can cause viral conjunctivitis?

A

Adenovirus, hsv, vsv, molluscum

419
Q

What is the clinical picture of acanthamoeba?

A

Pain, redness, blurred vision, photophobia, excess tearing

Associated with corneal injury

420
Q

What is the clinical presentation if trachoma

A

Most common cause if preventable blindness
Chlamydia in the eye, conjuctivitis,
Scarring under eyelid

421
Q

What is the clinical picture of ophthalmia neonatrum

A

Neonatal conjunctivitis, orbital pain, purulent discharged conjunctival hyperaemia

422
Q

What are the stages of dengue?

A

Febrile
Leaky capillaries
Convalescent

423
Q

What is the presentation of bacterial conjunctivitis?

A

Purulent, sticky, crusty discharge, conjunctival redness, foreign body sensation, no acuity change, no photophobia

424
Q

What is a red flag for bacterial conjuctivitis

A

Bilateral conjunctivitis

N. Gonorrhoea

425
Q

What is the clinical presentation of viral conjunctivitis?

A

Bilateral watery discharge, redness in one eye followed by the second a few darts later

426
Q

What can cause viral conjunctivitis?

A

Adenovirus, hsv, vsv, molluscum

427
Q

What is the clinical picture of acanthamoeba?

A

Pain, redness, blurred vision, photophobia, excess tearing

Associated with corneal injury

428
Q

What is the clinical presentation if trachoma

A

Most common cause if preventable blindness
Chlamydia in the eye, conjuctivitis,
Scarring under eyelid

429
Q

What is the clinical picture of ophthalmia neonatrum

A

Neonatal conjunctivitis, orbital pain, purulent discharged conjunctival hyperaemia

FOCP (12 decks)

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