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Infectious Diseases Flashcards

1
Q

TB Meningitis Tx

A

Rifampicin, Isoniazid, Pyrazinamide, Ethambutol for 2 months

R + I for 10 more months

+/- dexamethasone

+/- fludrocortisone

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2
Q

side effects of ethambutol

A

optic neuritis

AVOID if renal impairment (CrCl 10-50ml/min)

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3
Q

side effects of pyrazinamide

A

hepatitis

arthralgia

contraindicated in gout, porphyria

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4
Q

side effects of rifampicin

A

orange secretions

enzyme (CYP450) induction

hepatitis

if renal impairment-> reduce rifampicin dose by 50%

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5
Q

side effects of isoniazid

A

hepatitis

peripheral sensory neuropathy

(can give Vit B6 - pyridoxine alongside)

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6
Q

tx for latent TB

A

Rifampicin + Isoniazid for 3 months

or

Isoniazid alone for 6 months

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7
Q

hypopigmented, insensate plaques

trophic ulcers

thickened nerves

keratitis

A

mycobacterium leprae

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8
Q

pauci vs multibacillary leprosy

  • what is the difference?
A

Pauci: 2-5 spots

Multi: >5 spots

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9
Q

tx of lepromatous leprosy

(mycobacterium leprae)

A

tx for 2 years

rifampicin monthly

clofazamine + dapsone daily

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10
Q

tuberculoid vs lepromatous leprosy

  • who develops lepromatous leprosy?
A

failure of Th1 cell activation

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11
Q

tx of tuberculoid leprosy?

A

6 month tx

rifampicin monthly

clofazamine daily

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12
Q

mycobacterium avium intracellulare (MAI)

  • who is affected?
A

usually HIV patients / any immunosuppressed

CD4 <100

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13
Q

symptoms of MAI (mycobacterium avium intracellulare) complicating HIV infection

A

widely disseminated disease: lungs/ GIT

fever, night sweats, weight loss

diarrhoea

hepatomegaly

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14
Q

in immunocompromised host,

begins as a painless dermal papule or subcutaneous edematous nodule, which, over a period of weeks to months, breaks down to form an extensive necrotic ulcer with undermined edges

A

Buruli Ulcer

mycobacterium ulcerans

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15
Q

buruli ulcer

which organism?

A

mycobacterium ulcerans

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16
Q

fish tank granuloma

what organism?

A

mycobacterium marinum

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17
Q

oral neuraminidase inhibitor

against Influenza A and B

A

Oseltamivir

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18
Q

inhaled neuraminidase inhibitor

against Influenza A and B

A

Zanamivir

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19
Q

how does HIV seroconversion present?

A

transient illness 2-6 wks after exposure

fever, malaise, myalgia, pharyngitis, macpap rash

sore throat, lymphadenopathy

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20
Q

Dx of HIV?

A

HIV PCR

p24 antigen tests: usually +ve wk1 - wk3/4

screening ELISA- for serum anti-HIV Abs

confirmatory Western Blot: HIV Abs (95% by 4-6 wks)

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21
Q

Monitoring of HIV

using?

A

CD4 count

Viral Load (HIV RNA)

FBC, U+Es, LFTs, lipids, glucose

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22
Q

Ix of suspected HIV?

A

HIV diagnostic tests

Drug resistance studies

Mantoux test

Serology: CMV, toxo, HBV, HCV, syphilis

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23
Q

CD4<50 - prophylaxis against MAI?

A

azithromycin

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24
Q

HIV CD4 <100: prophylaxis against toxoplasmosis?

A

co-trimoxazole

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25
Q

HIV + CD4 <200: prophylaxis against PCP

A

co-trimoxazole

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26
Q

Diagnosing TB in HIV pts

problems?

A

higher false -ve skin tests

higher false -ve sputum cultures

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27
Q

presentation of PCP?

A

dry cough

exertional dyspnoea

fever

desaturation on exercise

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28
Q

CXR signs of PCP?

A

bilateral perihilar interstitial shadowing

may be normal

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29
Q

CMV in HIV patients causes?

A

CMV retinitis

+ pneumonitis, colitis, hepatitis

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30
Q

Tx for CMV retinitis in HIV pt

A

Ganciclovir

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31
Q

signs of CMV retinitis

A

decreased visual acuity

eye pain

photophobia

pizza sign on fundoscopy

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32
Q

CT/MRI head findings of toxoplasmosis

A

ring shaped contrast enhancing lesions

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33
Q

tx of toxoplasmosis in HIV pts

A

pyrimethamine

+

sulfadiazine

+

folate

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34
Q

presentation of toxoplasmosis in HIV Pts

A

posterior uveitis

encephalitis

focal neurology

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35
Q

tx for oral candidiasis?

A

nystatin suspension

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36
Q

tx of oesophageal candidiasis

A

PO itraconazole

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37
Q

presentation of oesophageal candidiasis?

A

dysphagia

retrosternal pain

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38
Q

Ix for suspected cryptococcal meningitis?

A

India Ink CSF stain

Raised CSF pressure

CrAg in blood and CSF

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39
Q

What virus causes progressive multifocal leukoencephalopathy?

A

JC virus

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40
Q

Tx of cryptococcal meningitis

A

Amphotericin B + Flucytosine for 2 wks

then

Fluclonazole for 6 months/ until CD4 count >200

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41
Q

Ix of suspected PML?

A

JC viral PCR

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42
Q

HIV patient

with

Weakness, paralysis, visual loss, cognitive decline.

you suspect a demyelinating inflammation of brain white matter

A

Progressive multifocal leukoencephalopathy

caused by JC virus

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43
Q

Mx of PML in HIV pt

A

HAART

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44
Q

benign recurrent aseptic meningitis?

A

mollaret’s meningitis

mostly HSV-2

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45
Q

Ix of herpes encephalitis

A

CSF findings: high lymphocytes

CSF PCR

MRI head

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46
Q

herpes infection

painful red finger

A

herpetic whitlow

mx: topical aciclovir

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47
Q

genital herpes

-> urinary retention + sacral sensory loss

A

Elsberg Syndrome

HSV-2 Sacral radiculiltis

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48
Q

Complications of chicken pox

A

pneumonitis

encephalitis

hepatitis

haemorrhage

increased risk in immunocompromised/ pregnancy

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49
Q

complications of shingles

A

post-herpetic neuralgia

(severe dermatomal pain)

Ramsay Hunt Syndrome

(Facial palsy, vesicles in ear, decreased taste/ hearing)

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50
Q

starry sky appearance

t(8;14)

c-myc

jaw or abdo mass

A

Burkitt’s lymphoma

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51
Q

what cells does EBV infect?

A

B lymphocytes

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52
Q

HIV pt

painless shaggy white plaque along lateral tongue border

A

oral hairy leukoplakia

EBV

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53
Q

tx of oral hairy leukoplakia

A

Aciclovir

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54
Q

lymphoma following solid organ transplant?

B cell proliferation

A

post-transplant lymphoproliferative disorder

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55
Q

Tx of post transplant lymphoproliferative disorder

A

Rituximab

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56
Q

mx of neisseria gonorrhoea?

A

ceftriaxone 500 mg IM + azithromycin 1 g oral

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57
Q

features of disseminated gonococcal infection?

A

tenosynovitis

migratory polyarthritis

dermatitis (lesions can be maculopapular or vesicular)

Later complications include septic arthritis, endocarditis and perihepatitis (Fitz-Hugh-Curtis syndrome)

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58
Q

pathophysiology of tetanus?

A

clostridium tetani produces exotoxin

  • > prevents the release of inhibitory transmitters GABA and glycine
  • > generalise muscle overactivity
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59
Q

presentation of tetanus?

A

prodrome: fever, malaise, headache

trismus

risus sardonicus (spasm of facial muscles that appears grinning)

opisthotonus (hyperextension of neck/ spine)

spasms may -> resp arrest

autonomic dysfunction: arrhythmias, fluctuating BP

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60
Q

Mx of tetanus?

A

Mx in ITU: may need intubation

Human tetanus Ig

Metronidazole, benpen

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61
Q

Prevention of tetanus?

A

active immunisation w tetanus toxoid

clean minor wounds

  • uncertain hx / <3 doses: give vaccin

3 or more doses: only vaccinate if > 10 yrs since last dose

Heavily contaminated wounds

  • uncertain hx/ < 3 doses: vaccine + Tetanus Ig

3 or more doses: vaccinate if 5 or more years since last dose

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62
Q

Actinomycosis features?

A

Subcut infections: esp. on jaw

Forms sinuses which discharge pus containing sulphur granules.

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63
Q

tx of actinomycosis?

A

Ampicillin for 30d, then Pen V for 100d

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64
Q

Swelling of eyelid (Romana’s sign)

fever, swollen lymph nodes, headaches, or local swelling at the site of the bite

enlargment of heart ventricles -> heart failure

enlargement of oesophagus/ colon

A

Chagas Disease

transmitted by kissing bugs (Reduviids)

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65
Q

diagnosis of african trypanosomiasis (sleeping sickness)?

A

thick and thin films -> flagellated protozoa

serology

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66
Q

Tender subcut nodule @ site of infection

Haemolymphatic Stage (1st stage):

  • rash, fever, rigors, headaches
  • itchiness
  • joint pains
  • LNs and HSM
  • Posterior cervical nodes (Winterbottom’s sign)

Miningoencephalitic Stage (2nd stage)

  • Wks – Mos after original infection
  • Convulsions, agitation confusion
  • Apathy, depression, hypersomnolence, coma
A

Sleeping sickness

African trypanosomiasis

transmitted by Tsetse fly

T. gambiense: more common, gradual onset

T. rhodesiense: rapid, more severe

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67
Q

skin ulcer @ bite -> depigmented scar

bitten by sandflies

A

Cutaneous Leishmaniasis

(L. major, L. tropica)

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68
Q

Bitten by sandflies

Widespread nodules which fail to ulcerate?

A

Diffuse cutaneous Leishmaniasis

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69
Q

bitten by sand flies

skin and mucosal ulcers with damage primarily of the nose and mouth

A

Mucocutaneous leishmaniasis (L braziliensis)

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70
Q

bitten by sandflies

Dry, warty hyperpigmented skin lesions (dark face and hands)

  • Prolonged fever
  • Massive splenomegaly, LNs, abdo pain
A

visceral leishmaniasis (Kala Azar)

L donovani

leishman-donovan bodies

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71
Q
A

lymphatic filariasis

  • Wuchereria bancrofti
  • elephantiasis
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72
Q

what carrier is responsible for transmitting dengue fever?

A

Aedes mosquito

(RNA virus)

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73
Q

features of dengue fever?

A

Flushes: face, neck, chest

Central macpap rash

Headache, arthralgia
Hepatosplenomegaly

Jaundice
Haemorrhage: petechial, GI, gums or nose, GU

NB. can exclude if fever starts >2wks after leaving endemic area.

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74
Q

mx of uncomplicated falciparum ovale, vivax, malariae?

A

chloroquine then primaquine

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75
Q

mx of uncomplicated falciparum malaria?

A

artemeter-lumefantrine (Riamet)

Quinine + doxy

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76
Q

mx of severe falciparum malaria?

A

need ITU mx

IV Quinine (Antimalarials)

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77
Q

Prophylaxis against malaria in pt w no resistance?

A

proguanil + chloroquine

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78
Q

prophylaxis against Malaria in pts with resistance?

A

mefloquine or Malarone (atovaquone + proguanil)

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79
Q

Which antimalarial causes haemolysis if G6PD deficiency?

A

primaquine

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80
Q

Diagnosis of malaria?

A

serial thick and thin blood films

parasitaemia level

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81
Q

Ix in malaria after diagnosis?

A

FBC: anaemia, thrombocytopenia

Clotting: DIC

Glucose

ABG: lactic acidosis

U+E: renal failure

Urinalysis: haemoglobinuria

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82
Q

features of falciparum malaria?

A

90% present within 1 month.

v acute illness

flu like prodrome: headache, myalgia, malaise

Rigors

fever every 3-4 days

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83
Q

signs in malaria?

A

anaemia

jaundice

hepatosplenomegaly

no rash, no LNs

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84
Q

which type of malaria species causes fever every 72 h?

(Quartan fever)

A

Plasmodium malariae

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85
Q

which type of malaria species causes tertian rhythm fever (every 48h)?

A

Plasmodium falciparum

Plasmodium vivax

& ovale

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86
Q

which species of malaria have a chronic liver stage?

A

vivax and ovale

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87
Q

pathophysiology of Malaria?

A

Plasmodium sporozoites injected by females Anopheles mosquito.

Sporozoites migrate to liver, infect hepatocytes and multiply asymptomatically (incubation period) → merozoites

Merozoites released from liver and infect RBCs

Multiply in RBCs

Haemolysis
RBC sequestration → splenomegaly

Cytokine release

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88
Q

Features of Primary Syphilis?

A

indurated, painless ulcer = Chancre

Regional LNs

Heals in 1-3wks

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89
Q

features of secondary syphilis?

A

6wks -6mo wks after chancre

Systemic bacteraemia → fever, malaise

Skin rash: Symmetrical, non-itchy, mac pap / pustular

Rash on Palms, soles, face, trunk

Buccal snail-track ulcers

Warty lesions: condylomata lata

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90
Q

features of tertiary syphilis?

A

2-20yrs latency

  1. Gummatous syphilis

Gummas: Granulomas in skin, mucosa, bones, joints

  1. Neurosyphilis

Tabes Dorsalis

Argyll Robertson pupil

dementia

  1. cardiovascular syphilis

Aortic aneurysm

Aortic regurg

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91
Q

features of Syphilitic aortitis?

A

Aortic aneurysm

Aortic regurg

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92
Q

features of Neurosyphilis?

A

Paralytic dementia

Meningovascular: CN palsies, stroke

Tabes dorsalis

  • Degeneration of sensory neurones, esp. legs
  • Ataxia and +ve Romberg’s
  • Areflexia
  • Plantars ↑↑
  • Charcot’s joints

Argyll-Robertson pupil

accommodates, doesn’t react

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93
Q

Diagnosis of Syphilis?

A

Cardiolipin antibody

E.g. VDRL, RPR

Not treponeme specific

False +ve: pregnancy, pneumonia, SLE, malaria, TB

+ve in 1O and 2O syphilis (wanes in late disease)

Reflects disease activity: -ve after Rx

Treponeme-specific Ab

+ve in 1O and 2O syphilis

Remains +ve despite Rx

THPA and FTA

Treponemes

Seen by dark ground microscopy of chancre fluid

Seen in lesions of 2O syphilis

May not be seen in late syphilis

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94
Q

What marker is used to monitor disease activity in syphilis?

A

RPR

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95
Q

What test would remain +ve even after tx of syphilis?

A

THPA and FTA:

treponene-specific Ab

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96
Q

Mx of syphilis?

A

IM Benzathine Penicillin 2-3 doses

or Doxycycline for 28 days

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97
Q

What reaction is common after receiving tx for syphilis?

A

Jarisch-Herxheimer Reaction

Fever, ↑HR, vasodilatation hrs after first Rx

? sudden release of endotoxin

Rx: steroids

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98
Q

features of Jarisch-Herxheimer reaction?

A

Fever, ↑HR, vasodilatation hrs after first Rx

? sudden release of endotoxin

Rx: steroids

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99
Q

Mx of travellers diarrhoea?

E coli

A

Cipro

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100
Q

Commonest bacterial diarrhoea

Bloody diarrhoea, fever

assoc w Guillain-Barre + Reactive arthritis

A

Campylobacter jejuni

  • unpasteurized milk, animal faeces

2-5d incubation

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101
Q

Mx of Campylobacter jejuni GI infection?

A

Dx by stool MCS

erythromycin

or

Ciprofloxacin

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102
Q

Commonest cause of diarrhoea/ vomiting in adults

50% of all gastroenteritis worldwide

Fever, diarrhoea, projectile vomiting

A

Norovirus

12-48h incubation time

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103
Q

Commonest cause of diarrhoea in children

Secretory diarrhoea and vomiting

A

Rotavirus

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104
Q

Profuse diarrhoea, abdo pain, vomiting

assoc w Raw/undercooked seafood

Japan

A

Vibrio parahaemolyticus

tx: Doxycycline

100-200mg/d PO

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105
Q

Rice-water stools

Shock, acidosis, renal failure

A

Vibrio cholera

Faecal-oral spread

Dirty water

hrs-5d incubation

diagnosis by stool MCS

106
Q

Mx of vibrio cholera?

A

dx by stool MCS

Rehydrate

  • Cooked rice powder solution
  • Hartmann’s w K+ supplements

Cipro

Zn supplement

107
Q

Watery diarrhoea + cramps

assoc w gas gangrene

A

Clostridium perfringens

  • assoc w reheated meat
108
Q

Mx of clostridium perfringens?

A

Diagnosis by stool MCS

Benpen + metro

109
Q

Afebrile

Descending symmetric flaccid paralysis

No sensory signs

Autonomic: dry mouth, fixed dilated pupils

recently eaten canned/ vacuum packed food

Kids = honey

students = beans

A

Clostridium botulinum

dx: Toxin in blood samples

110
Q

Mx of clostridium botulinum?

A

Antitoxin

Benpen + metro

111
Q

Bloody diarrhoea, abdo pain, fever - foul smelling

Pseudomembranous colitis

Toxic megacolon

GI perforation

A

C difficile

assoc w antibiotic use

cephalopsporins, ciprofloxacin, clindamycin

Faecal oral spread

Environment: spores

112
Q

Mx of C difficile?

A

Stop causative Abx

1st: Metronidazole 400mg TDS PO for 10d
2nd: Vanc 125mg QDS PO

Colectomy may be needed

113
Q

Watery diarrhoea, cramps, flu-like

Pneumonia

Meningoencephalitis

Miscarriage

assoc w refrigerated food, soft cheeses, pates

A

Listeria monocytogenes

114
Q

Mx of listeria monocytogenes?

A

diagnosis by blood culture

Ampicillin

115
Q

Diarrhoea, vomiting, fever, abdo pain

Poultry, eggs, meat

A

Salmonella enteritidis

116
Q

features of gonorrhoea?

A

Men: - Purulent urethral discharge, dysuria, prostatitis

Women: - Usually asympto, dysuria, discharge

117
Q

diagnosis of Gonorrhoea?

A

Urine NAATs

Culture is gold standard

  • Intracellular Gm- diplococci
  • Transport in Stuart’s Medium
118
Q

Mx of gonorrhoea?

A

Cefixime PO

Ceftriaxone IM

+

azithromycin

119
Q

complications of gonorrhoea?

A

Prostatitis

Epididymitis

Salpingitis / PID

Reactive Arthritis

Ophthalmia neonatorum

120
Q

Features of chlamydia?

A

v common iin <25 yr group

Asympto in 50% men and 80% women

Men: - Urethritis

Women: - Cervicitis, urethritis, salpingitis

121
Q

diagnosis of chlamydia?

A

1st line NAATs (Nucleic Acid Amplification Test)

  • Urine

Culture

  • Endocervical swab
  • Discharge
122
Q

mx of chlamydia?

A

Azithromycin 1g PO once

or

Doxycycline PO 100mg BD for 7 days

123
Q

complications of chlamydia?

A

Prostatitis

Epididymitis

Salpingitis / PID

increased incidence of ectopic pregnancies

Reactive Arthritis

Opthalmia neonatorum

perihepatitis (Fitz-Hugh-Curtis syndrome)

124
Q

features of Lymphogranuloma venereum

primary stage?

A

caused by the invasive serovars L1, L2, L2a or L3 of Chlamydia trachomatis

primarily an infection of lymphatics and lymph nodes.

common in MSM

tropical STI

  • painless genital ulcer, heals fast
  • balanitis, proctitis, cervicitis
125
Q

features of lymphogranuloma venereum?

Inguinal syndrome

A

caused by the invasive serovars L1, L2, L2a or L3 of Chlamydia trachomatis

primarily an infection of lymphatics and lymph nodes.

common in MSM

tropical STI

  • Painful inguinal buboes
  • Fever, malaise → genital elephantiasis
126
Q

features of lymphogranuloma venereum?

anorectal syndrome

A

caused by the invasive serovars L1, L2, L2a or L3 of Chlamydia trachomatis

primarily an infection of lymphatics and lymph nodes.

common in MSM

tropical STI

  • Proctocolitis → Rectal strictures → Abscesses and fistulae
127
Q

diagnosis of lymphogranuloma venereum?

A

Chlamydia serovars L1, L2, L3

NAATs

128
Q

Mx of lymphogranuloma venereum?

A

Azithromycin / doxycycline

129
Q

Complications of lymphogranuloma venereum?

A

Genital elephantiasis

Rectal strictures

130
Q

features of HPV 6/11

A

often asymptomatic

genital warts

131
Q

Mx of genital warts

A

multiple, non-keratinised warts: topical podophyllum

solitary, keratinised warts: Cryotherapy

132
Q

Features of HSV?

A

Flu-like prodrome

Inguinal LNs

Painful grouped vesicles → ulcers

Dysuria may -> urinary retention

133
Q

diagnosis of HSV

A

PCR

Serology

134
Q

mx of HSV

A

Analgesia

Aciclovir

cold sores: topical aciclovir

135
Q

Complications of HSV?

A

Meningitis

Elsberg Syndrome: sacral radiculomyelitis → retention + saddle paraesthesia

136
Q

sacral radiculomyelitis → retention + saddle paraesthesia

HSV?

A

Elsberg syndrome

137
Q

features of Chancroid?

A

Papule → Painful soft genital ulcer

  • base covered in yellow/grey

Progressing to inguinal buboes

Haemophilus ducreyi

mainly Africa

138
Q

Diagnosis of Chancroid?

A

Haemophilus ducreyi

  • Culture
  • PCR
139
Q

Mx of Chancroid?

A

Azithromycin

140
Q

Features of Donovanosis?

A

aka Granuloma inguinale

  • Klebsiella granulomatis

Painless, beefy-red ulcer

Subcutaneous inguinal granulomas = Pseudobuboes

Possible elephantiasis

141
Q

Diagnosis of Donovanosis?

A

Donovan bodies

  • Giemsa stain
142
Q

Mx of Donavonosis?

A

Erythromycin

143
Q

secretory vs inflammatory diarrhoea?

A

Secretory Diarrhoea

Bacteria only found in lumen: don’t activate innate immunity

No / low fever

No faecal leukocytes

Caused by bacterial toxins: Cholera, E. coli (except EIEC), S. aureus

Toxin → ↑cAMP→ open CFTR channel → Cl loss followed by HCO3, Na and H2O loss → secretory diarrhoea

Inflammatory Diarrhoea

Bacteria invade lamina propria: activate innate immunity

Fever

PMN in stool

Campylobacter, shigella, non-typhoidal salmonella, EIEC

144
Q

malaise, headache, cough, constipation

high fever w relative bradycardia

Rose spots: patchy red macules

Epistaxis, splenomegaly

Diarrhoea after 1st wk

A

Salmonella typhi/paratyphi

(typhoid fever)

incubates 3-21d

145
Q

main features of typhoid fever?

A

constipation

high fever w relative bradycardia

Rose spots: patchy red macules

splenomegaly

146
Q

diagnosis of typhoid fever?

A

Leukopenia
Blood culture: salmonella typhi/ paratyphi
Urine or stool culture

147
Q

mx of typhoid fever?

A

Cefotaxime or cipro

148
Q

abdo pain, fever, diarrhoea

Mesenteric adenitis
Reactive arthritis, pharyngitis, pericarditis

Erythema Nodosum

A

Yersinia enterocolitica

dx: by serology
mx: cipro

149
Q

Bloating, explosive diarrhoea, offensive gas

Malabsorption → steatorrhoea and wt. loss

symptoms for 1-4wk

assoc w MSM, Hikers, Travellers

A

Giardia lamblia

150
Q

diagnosis of giardia?

A

Direct fluorescent Ab assay

Stool microscopy: Pear-shaped trophozoites w 2 nuclei

Duodenal fluid analysis on swallowed string

151
Q

mx of giardia?

A

Tinidazole

152
Q

Who should be screened for MRSA?

A

all patients awaiting elective admissions

(exceptions include day patients having terminations of pregnancy and ophthalmic surgery. Patients admitted to mental health trusts are also excluded)

all emergency admissions screened

153
Q

How should a patient be screened for MRSA?

A

nasal swab and skin lesions or wounds

the swab should be wiped around the inside rim of a patient’s nose for 5 seconds

the microbiology form must be labelled ‘MRSA screen’

154
Q

Suppression of MRSA from a carrier once identified?

A

nose: mupirocin 2% in white soft paraffin, tds for 5 days
skin: chlorhexidine gluconate, od for 5 days.

Apply all over but particularly to the axilla, groin and perineum

155
Q

what antibiotics are commonly used in the treatment of MRSA infections?

A

vancomycin

teicoplanin

linezolid

156
Q

recommended abx for Hospital-acquired pneumonia?

A

Within 5 days of admission: co-amoxiclav or cefuroxime

More than 5 days after admission: piperacillin with tazobactam

OR a broad-spectrum cephalosporin (e.g. ceftazidime) OR a quinolone (e.g. ciprofloxacin)

157
Q

recommended abx for Exacerbations of chronic bronchitis?

A

Amoxicillin or tetracycline or clarithromycin

158
Q

recommend abx for UTI?

A

Trimethoprim or nitrofurantoin.

Alternative: amoxicillin or cephalosporin

159
Q

Recommended abx for acute prostatis?

A

Quinolone (e.g. cipro) or trimethoprim

160
Q

recommended abx for Acute pyelonephritis?

A

Broad-spectrum cephalosporin or quinolone (e.g. cipro)

161
Q

recommended abx for Animal or human bite?

A

Co-amoxiclav

(doxycycline + metronidazole if penicillin-allergic)

162
Q

recommended abx for Mastitis during breast-feeding?

A

Flucloxacillin

163
Q

recommended abx for Erysipelas?

A

Flucloxacillin (erythromycin if penicillin-allergic)

164
Q

recommended abx for Cellulitis?

A

Flucloxacillin

(clarithromycin or clindomycin if penicillin-allergic)

165
Q

recommended abx for Impetigo?

A

Topical fusidic acid

oral flucloxacillin or erythromycin if widespread

166
Q

recommended abx for Throat infections?

A

Phenoxymethylpenicillin

(erythromycin alone if penicillin-allergic)

167
Q

recommended abx for Sinusitis?

A

Amoxicillin or doxycycline or erythromycin

168
Q

recommended abx for Otitis media?

A

Amoxicillin (erythromycin if penicillin-allergic)

169
Q

recommended abx for Otitis externa*?

A

Flucloxacillin (erythromycin if penicillin-allergic)

170
Q

recommended abx for Periapical or periodontal abscess?>

A

Amoxicillin

171
Q

recommended abx for Gingivitis: acute necrotising ulcerative?

A

Metronidazole

172
Q

recommended abx for Pelvic inflammatory disease?

A

Oral ofloxacin + oral metronidazole

or IM ceftriaxone + oral doxycycline + oral metronidazole

173
Q

recommended abx for Chlamydia?

A

Doxycycline or azithromycin

174
Q

recommended abx for Gonorrhoea?

A

IM ceftriaxone + oral azithromycin

175
Q

recommended abx for Syphilis?

A

Benzathine benzylpenicillin or doxycycline or erythromycin

176
Q

recommended abx for Bacterial vaginosis?

A

Oral or topical metronidazole or topical clindamycin

177
Q

recommended abx for Shigellosis/ Salmonella (non-typhoid)?

A

Ciprofloxacin

178
Q

painful vs painless Genital ulcers?

A

painful: herpes, chancroid
painless: syphilis, lymphogranuloma venereum (may have painful inguinal lymphadenopathy)

179
Q

dysentery, wind, tenesmus

weight loss if chronic

liver abscess

  • RUQ pain, swinging fever, sweats
  • mass in R lobe

flask shaped ulcer on histo

A

Entamoeba histolytica

assoc w MSM, travelling

1-4 wks incubation

180
Q

features of Entamoeba histolytica?

A

dysentery, wind, tenesmus

weight loss if chronic

liver abscess

  • RUQ pain, swinging fever, sweats
  • mass in R lobe

flask shaped ulcer on histo

assoc w MSM, travellers

181
Q

Diagnosis of entamoeba histolytica?

A

Stool micro:

  • motile trophozoite w 4 nuclei

Stool Ag

182
Q

Mx of Entamoeba histolytica?

A

Metronidazole

  • Tindazole if severe or abscess
183
Q

Migrating urticarial rash on trunk and legs

Pneumonitis, enteritis
Malabsorption → chronic diarrhoea

A

Strongyloides stercoralis

Endemic in sub-tropics

Hyperinfestation in AIDS

mx: Ivermectin

184
Q

what is enteric fever?

A

Abdo pain, fever, mononuclear cells in stool

e.g Typhoidal salmonella, Yersinia enterocolitica, Brucella

185
Q

features of Rabies?

A

animal bites

Prodrome: headache, malaise, itch, odd behaviour

Furious Rabies: Hydrophobia, Muscle spasms

hypersalivation

Dumb Rabies: flaccid limb paralysis

186
Q

Diagnosis of Rabies?

A

“bullet shaped” RNA virus

Negri bodies

187
Q

Mx of rabies?

A

immunised:

diploid vaccine

Unimmunised:

vaccine + rabies Ig

188
Q

features of Toxoplasmosis?

A

cats are definitive hosts

mostly asympto

reactivated in immunodeficiency

  • > encephalitis: confusion, seizures, focal
  • > SOL/ raised ICP
  • > Posterior uveitis
189
Q

Diagnosis of Toxoplasmosis?

A

CT/ MRI head: ring-shaped contrast enhancing CNS lesions

Serology

190
Q

Mx of toxoplasmosis?

A

Pyrimethamine + sulfadiazine

Septrin (co-trimoxazole) Prophylaxis in HIV

191
Q

features of cat scratch disease?

A

bartonella henselae

hx of cat scratch

tender regional LNs

192
Q

Mx of cat scratch disease?

A

Azithromycin

Diagnosis: +ve cat scratch skin Ag test

193
Q

Features of Anthrax?

A

Cutaneous

  • ulcer w Black centre
  • rim of oedema

Inhalational:

  • massive Lymphadenopathy
  • mediastinal haemorrhage
  • resp failure

GI

  • severe bloody diarrhoea
194
Q

Mx of anthrax?

A

Cipro + clindamycin

195
Q

features of Lyme Disease?

A

Borrelia burgdorferi

Ixodes tick bite

walkers, hikers

Early localised: erythema migrans (target lesions)

Early disseminated: mirgatory arthritis, malaise, LN, hepatitis

Late persistent:

Arthritis, focal Neuro (Bells Palsy), heart block, myocarditis

Lymphocytoma: blue/ red ear lobe

196
Q

Mx of Lyme Disease?

A

Rash: Doxycycline

Complications: IV benpen

197
Q

Undulant Fever (PUO): peak PM, normal AM

sweats, malaise, anorexia

arthritis, spinal tenderness

LN, HSM

Rash, jaundice

assoc w unpasteurised milk/ cheeses

A

Brucellosis

Diagnosed by pancytopenia,

Positive Rose Bengal Test: anti-O-polysaccharide Ag

198
Q

Mx of Brucellosis?

A

Doxy + Rifampicin + Gent

199
Q

High fever, headache, myalgia / myositis

Cough, chest pain ± haemoptysis
± hepatitis w jaundice
± meningitis

assoc w infected rat urine, swimming, canoeing

A

Leptospirosis

mx: doxycycline

200
Q

presentation of Hepatitis A?

A

prodromal phase:

fever, malaise, arthralgia, nausea, anorexia

distaste for cigarettes

Icteric phase:

jaundice, HSM, lymphadenopathy, cholestasis

201
Q

Ix of hepatitis A?

A

↑↑ALT, ↑AST (AST:ALT <2)

IgM+ ~25d after exposure = recent infection

IgG+ for life

202
Q

Mx of Hepatitis A?

A

Supportive

Avoid alcohol

IFN-a for fulminant hepatitis

prevention: passive Ig -> <3 mo protection

can give active vaccine

203
Q

Ix of Hep B?

A

HBsAg +ve = current infection
+ve >6mo = chronic disease

HBeAg +ve = high infectivity

Anti-HBc IgM = recent infection

Anti-HBc IgG = past infection

Anti-HBs Ab = cleared infection or vaccinated

HBV PCR: monitoring response to Rx

204
Q

complications of Hep B?

A

Fulminant hepatic failure

Chronic hepatitis (5-10%) -> cirrhosis in 5%

HCC

glomerulonephritis

polyarteritis nodosa

cryoglobulinaemia

205
Q

Ix of Hep C?

A

Anti-HCV Abs

HCV-PCR

Liver biopsy if PCR +ve to assess liver damage and need for tx

HCV genotype

206
Q

Mx of Hepatitis C?

A

Indications

  • Chronic haepatitis
  • ↑ ALT
  • Fibrosis

treatment depends on viral genotype - test prior to tx

combination of protease inhibitors (e.g. daclatasvir + sofosbuvir or sofosbuvir + simeprevir) +/- ribavarin

↓ efficacy if:

  • Genotype 1, 4, 5 or 6
  • ↑ VL
  • Older
  • Black
  • Male
207
Q

what diseases are assoc w EBV?

A

Infectious mononucleosis

Burkitt’s lymphoma

Post Transplant Lymphoproliferative Disorder

Oral hairy leukoplakia

Primary brain lymphoma

Nasopharyngeal Ca

208
Q

Jaw or abdo mass
Endemic: Africa, malaria
Sporadic: non-African, impaired immunity

Immunodeficiency: HIV or post-Tx

A

Burkitt’s lymphoma

209
Q

Diagnosis of Burkitt’s lymphoma?

A

Starry-sky appearance

CD10, BCL6

t(8;14)

210
Q

complications of infectious mono?

A

splenic rupture

CN lesion (e.g. 7)

ataxia GBS

pancytopenia with megaloblastic marrow

meningoencephalitis

chronic fatigue

211
Q

Diagnosis of Infectious mono?

A

Lymphocytosis

Atypical Lymphocytes

+ve heterophile abs: Monospot, Paul Bunnell

NICE guidelines suggest FBC and Monospot in the 2nd week of the illness to confirm a diagnosis of glandular fever.

Blood: serology, PCR

212
Q

features of infectious mono?

A

Saliva or droplet spread
Fever, malaise, sore throat, cervical LNs +++

Splenomegaly, hepatitis (→ hepatomegaly and jaundice)

213
Q

features of CMV reactivation?

A

immunocomprised

HIV: retinitis > colitis > CNS disease

Transplant: penumonitis > colitis > hepatitis > retinitis

214
Q

Diagnosis of CMV?

A

Blood; PCR, serology

Owl’s Eye intranuclear inclusions

Atypical Lymphocytes

215
Q

Mx of PCP?

A

co-trimoxazole

IV pentamidine in severe cases

steroids if hypoxic (if pO2<9.3 kPa then steroids reduce risk of resp failure by 50% and death by 1/3)

216
Q

choice of antibiotic for UTI in breastfeeding mother?

A

Trimethoprim

217
Q

most common infective cause of diarrhoea in HIV patients?

A

Cryptosporidium

Presentation is very variable, ranging from mild to severe diarrhoea

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

Treatment is difficult, with the mainstay of management being supportive therapy*

218
Q

what organism may cause diarrhoea in HIV pts w CD4 count <50?

A

Mycobacterium avium intracellulare

ypical features include fever, sweats, abdominal pain and diarrhoea.

may be hepatomegaly and deranged LFTs.

Diagnosis is made by blood cultures and bone marrow examination

Management is with rifabutin, ethambutol and clarithromycin

219
Q

what organism is most common in bronchiolitis?

A

Respiratory syncytial virus

220
Q

what organism is most responsible in croup?

A

parainfluenza virus

221
Q

what organism is most responsible for pneumonia following influenza?

A

staph aureus

222
Q

Atypical pneumonia

Classically spread by air-conditioning systems, causes dry cough.

Lymphopenia, deranged liver function tests and hyponNa may be seen

A

Legionella pneumophilia

223
Q

post-exposure prophylaxis for Hep A?

A

Human Normal Immunoglobulin (HNIG) or hep A vaccine

224
Q

Post-exposure prophylaxis for Hep B?

A

HBsAg positive source: hepatitis B immune globulin (HBIG) and accelerated course of the vaccine

unknown source: HBIG and accelerated course of the HBV vaccine

225
Q

Post-exposure prophylaxis for Hep C?

A

monthly PCR - if seroconversion then interferon +/- ribavirin

226
Q

Post-exposure prophylaxis of HIV?

A

combination of oral antiretrovirals (e.g. Tenofovir, emtricitabine, lopinavir and ritonavir) asap (i.e. Within 1-2 hours, but may be started up to 72 hours following exposure) for 4 weeks

serological testing at 12 weeks following completion of PEP

227
Q

diagnosis of legionella pneumophilia?

A

urinary antigen

tx: w erythromycin

228
Q

mx of infectious mono?

A

supportive

rest during the early stages, drink plenty of fluid, avoid alcohol

simple analgesia for any aches or pains

avoid playing contact sports for 8 weeks after having glandular fever to reduce the risk of splenic rupture

229
Q

main test to check for latent TB?

A

Mantoux test

IGRA:

when Mantoux test is positive or equivocal

people where a tuberculin test may be falsely negative:

miliary TB

sarcoidosis

HIV

lymphoma

very young age (e.g. < 6 months)

230
Q

HIV+ve

associated with the Epstein-Barr virus

CT: single or multiple homogenous enhancing lesions

A

Primary CNS lymphoma

treatment generally involves steroids (may significantly reduce tumour size), chemotherapy (e.g. methotrexate) + with or without whole brain irradiation. Surgical may be considered for lower grade tumours

231
Q

Toxoplasmosis vs primary CNS lymphoma?

A

Toxoplasmosis

Multiple lesions
Ring or nodular enhancement
Thallium SPECT negative

Lymphoma

Single lesion
Solid (homogenous) enhancement
Thallium SPECT positive

232
Q

most common fungal infection of CNS?

A

Cryptococcus

headache, fever, malaise, nausea/vomiting, seizures, focal neurological deficit

233
Q

Ix of cryptococcus?

A

CSF: high opening pressure, India ink test positive

CT: meningeal enhancement, cerebral oedema

234
Q

widespread demyelination

due to infection of oligodendrocytes by JC virus (a polyoma DNA virus)

symptoms, subacute onset : behavioural changes, speech, motor, visual impairment

MRI is better - high-signal demyelinating white matter lesions are seen

A

Progressive multifocal leukoencephalopathy (PML)

235
Q

Pneumonia in an alcoholic?

A

Klebsiella pneumoniae

236
Q

mx of anti-HbS <10 mIU/ml after undergoing primary immunisation against hep B?

A

Non-responder.

Test for current or past infection.

Give further vaccine course (i.e. 3 doses again) with testing following.

If still fails to respond then HBIG would be required for protection if exposed to the virus

237
Q

mx of anti-HbS 10-100 mIU/ml after undergoing primary immunisation against hep B?

A

Suboptimal response

  • one additional vaccine dose should be given.

If immunocompetent no further testing is required

238
Q

mx of anti-HbS >100 mIU/ml after undergoing primary immunisation against hep B?

A

Indicates adequate response, no further testing required.

Should still receive booster at 5 years

239
Q

recommended abx prophylaxis for close contacts of pt w meningococcal meningitis?

A

oral ciprofloxacin (preferred) or rifampicin or may be used

240
Q

abx for mengingitis caused by listeria?

A

IV amoxicillin + gentamicin

241
Q

Mx of rabies immunised person who just got an animal bite?

A

the wound should be washed

if an individual is already immunised then 2 further doses of vaccine should be given

if not previously immunised then human rabies immunoglobulin (HRIG) should be given along with a full course of vaccination. If possible, the dose should be administered locally around the wound

242
Q
A

Kaposi’s sarcoma
caused by HHV-8

presents as purple papules or plaques on the skin or mucosa

may later ulcerate

respiratory involvement may cause massive haemoptysis and pleural effusion

243
Q

Mx of kaposis sarcoma?

A

radiotherapy + resection

244
Q

what virus causes progressive multifocal leukoencephalopathy?

245
Q

what type of medications should be stopped during a c diff infection?

A

medications which are anti motility or anti-peristaltic (e.g. opioids)

246
Q

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

A

at least 2 weeks before surgery

247
Q

mx of bacterial vaginosis?

A

metronidazole

Treatment should be offered to all pregnant woman who are symptomatic. Symptomatic BV in pregnancy is associated with late miscarriage and preterm delivery.

248
Q

what organism is mainly implicated in bacterial vaginosis?

A

Gardnerella vaginalis

This leads to a consequent fall in lactic acid producing aerobic lactobacilli resulting in a raised vaginal pH.

249
Q

What are Ansels criteria for diagnosis of BV?

A

3 of the following 4 points should be present:

thin, white homogenous discharge

clue cells on microscopy: stippled vaginal epithelial cells

vaginal pH > 4.5

positive whiff test (addition of potassium hydroxide results in fishy odour)

250
Q

Malignancies associated with EBV infection

A

Burkitt’s lymphoma*

Hodgkin’s lymphoma

nasopharyngeal carcinoma

HIV-associated central nervous system lymphomas

251
Q

which pneumonia commonly causes reactivation of the herpes simplex virus resulting in ‘cold sores’?

A

Streptococcus pneumoniae

252
Q

diagnosis of mycoplasma pneumoniae?

A

diagnosis is generally by Mycoplasma serology

positive cold agglutination test

253
Q

PEP for Hep C?

A

monthly PCR - if seroconversion then interferon +/- ribavirin

254
Q

PEP for HIV?

A

a combination of oral antiretrovirals (e.g. Tenofovir, emtricitabine, lopinavir and ritonavir) as soon as possible (i.e. Within 1-2 hours, but may be started up to 72 hours following exposure) for 4 weeks

serological testing at 12 weeks following completion of post-exposure prophylaxis

255
Q

most common causes of meningitis in 0-3 mo old?

A

Group B Streptococcus (most common cause in neonates)

E. coli

Listeria monocytogenes

256
Q

Causes of meningitis is immunosuppressed?

A

Listeria monocytogenes

257
Q

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

Councilman bodies (inclusion bodies) may be seen in the hepatocytes

A

Yellow fever

Type of viral haemorrhagic fever (also dengue fever, Lassa fever, Ebola).

258
Q

live attenuated vaccines?

A

BCG

measles, mumps, rubella (MMR)

influenza (intranasal)

oral rotavirus

oral polio

yellow fever

oral typhoid

259
Q

Toxoid (inactivated toxin) vaccines?

A

tetanus

diphtheria

pertussis

260
Q

Inactivated preparations
vaccines?

A

rabies

hepatitis A

influenza (intramuscular)

Medicine (16 decks)

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