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Final > Infectious diseases > Flashcards

Infectious diseases Flashcards

1
Q

E.G Gram positive

A

Strep, Staph

C.diff - Anaerobic bacilli

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2
Q

E.G Gram negative

A 
E.coli
Klebsiella
Salmonella
shigella
Vibrio cholera
Neisseria (meningitidis, gonorrhoea)
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3
Q

Non Gram staining Bacteria

A

Mycobacteria (Ziehl-Neelsen)

Chlamydia e.g. Trachomatis (obligate intracellular)

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4
Q

Vancomycin / Teicoplanin Pathogen and SE

A

Severe sepsis (MRSA, C.diff)

SE: nephrotoxic, ototoxic

CI: renal fail, deafness

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5
Q

Benzylpenicillin

Pathogen and SE

A

Strep infections inc pneumoniae, Neisseria (meningitidis & gonococcal), syphilis

SE: hypersensitivity/anaphylaxis

CI: allergic

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6
Q

Flucloxacillin Pathogen and SE

A 
Staph aureus 
Strep pyogenes (GrpAS)

SE: hypersensitivity/anaphylaxis

CI: allergic§

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7
Q

Amoxicillin Pathogen and SE

A

UTIs, RTIs
Enterococcal infection

SE: nausea & vomiting

CI: Penicillin hypersensitivity

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8
Q

3rd gen Cephalosporins E.G. + Pathogen and SE

A

Ceftriaxone & Cefotaxime (Cefotaxime preferred in Neonates)

Staph aureus
Streptococci, Nisseria (used in meningitis), haemophilus

SE: Abx assoc colitis, Stephens-Johnson

CI: allergy

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9
Q

Penicillin drug examples

A

Amoxicillin/Co-amoxlclav (with clavulanic acid)
Benzypenicillin
Phenoxymethylpenicillin (Penicillin V)
Flucloxacillin

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10
Q

Beta lactam Abx

A

Penicillins, cephalosporins

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11
Q

Trimethoprim when used, SE and CI

A

UTI, prostatitis, acute/chronic bronchitis

CI in preg (folate synth inhibitor) - use nitrofurantoin instead, blood dyscarias

SE: hyperkalaemia, depressed haematopoiesis

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12
Q

Metronidazole when used, CI + SE

A

Anaerobes, Prophylaxis in GI surgery

SE: taste disturbance, anorexia

CI: interaction with alcohol - profuse vomiting

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13
Q

Chloramphenicol main indication & SE

A

H-influenzae b Epiglottitis

SE: Aplastic anaemia, optic neuritis, erythema multiforme

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14
Q

Macrolide e.g., used against & SE

A

Clarithromycin&Erythromycin

(Good substitiute if allergic to penicillin)

Strep pneumoniae, Staph aureus, legionella, Chlamydia

SE: Arrhythmia, Stephens-Johnson
CI: hepatic impairment

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15
Q

Doxycycline used against & SE

A

Broad spec
Strep (pneumoniae, viridians, pyogenes)
Staph aureus, chlamydia

SE: photosensitivity, oesophageal irritation

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16
Q

Aminoglycosides e.g., used against & SE

A

Gentamycin&streptomycin

Gent used against staph aureus, gram -ve bacilli (e.coli etc)

Used for severe sepsis

SE: nephrotoxic, vestibular/auditory damage

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17
Q

HIV pathophys

A

Enters cell via receptor (GP120) on virus binding to CD4 on T-cells, Macrophages, monocytes, glial cells

CD4 cells migrate to lymphoid tissue -> viral replication -> new visions to new Th-cells

Subsequent damage and depletion of CD4 cells = dec immune function

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18
Q

How doe HIV viral replication occur

A

Reverse transcription (error prone - allow viral mutation and escape) and genomic integration (integrase)

Transcription of viral mRNA by CD4

mRNA translated into new proteins = new virus -> budding

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19
Q

Why doesn’t HIV generate an immune response?

A

Low magnitude of HIV antibodies prod.

Glycoprotein envelope poorly immunogenic

Mutation prone reverse transcription = viral mutation = viral escape

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20
Q

Transmission and who at risk

A

Blood, sex, vertical (mother to child)

IVDU, african, commercial sex worker, multiple partners

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21
Q

Life expect HIV when is this less

A

Near normal

X10 risk of death if late diagnosis

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22
Q

When to suspect HIV

A

Generalised lymphadenopathy

Acute rash

Flu-like/Glandular fever like

Prolonged herpes simplex (cold sores)

mouth lesions

Unexplained weight loss & night sweats

Recurrent bacterial infection

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23
Q

HIV diagnosis

A

1) ELISA (assay looking for HIV Antibodies and antigens)
2) Western blot (expensive and confirmatory)
3) Serum p24 (HIV antigen)
4) Serum CD4/HIV RNA (PCR)

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24
Q

When is HIV detectable

A

Assay tests +ve in 95% at 4 week and 99% at 12 weeks

p24 detectable at 4 weeks

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25
Q

HIV severity parameters

Treatment aim

A

CD4 count

Viral load

Used to determine how advanced and to monitor Tx response

CD4 over 400cells/mm3
Viral load = 0

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26
Q

Normal CD4 range

A

450-1600 cells/mm3

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27
Q

Stages of HIV

A

Seroconversion: (antibody to HIV detectable in blood, antigen undetectable)
- Fever, aches, rash, headache, diarrhoea, mouth ulcers

Asympt:

  • May last years
  • Progressive loss of CD4
  • 30% generalised lymphadenopathy

Symptomatic HIV:

  • Opportunistic infection
  • Kaposi sarcoma/lymphoma

AIDS:

  • Worsening of symptomatic
  • Pyrexia, night sweats, diarrhoea, Wt lss
  • Oral candida/herpes zoster/simplex
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28
Q

AIDS:

  • Def
  • When dev
  • Diag
A

Acquired immune deficiency syndrome

HIV without Tx in 5-10 years

HIV +ve + AIDS defining condition (Pneumocystis pneumonia, CMV, TB, Toxoplasmosis - brain lesion, tumour - kapok’s sarcoma or lymphoma)

29
Q

Opprtunistic infections in HIV

A 
TB
Pneumocystis pneumonia (fungal)
Candidiasis (oral/bronchial/oesophageal)
Cryptococcal meningitis 
Toxoplasmosis
SMV
30
Q

Cancers in HIV

A

Burkitt’s lymphonma (NHL)

Kaposi’s sarcoma (HHV8)

31
Q

HIV organ system effect:

Lung
GI
Eye
CNS
Psych
Cancer
A 
Lung:
- TB, S.pneum, H.inf
GI:
- Oral candida
- Salmonella, C.diff
Eye:
- CMV retinitis
-Toxoplasmosis eye disease
CNS:
- Cerebral toxoplasmosis (Ring on CT)
- TB meningitis
- CNS lymphoma
Psych:
- HIV dementia
Cancer:
- HPV: cervical ca
- HHV: Kaposi
- EBV: NHL (Burkitt)
32
Q

Prophylactic Abx in HIV:

A

Co-trimoxazole (toxoplasmosis,)

Isoniazid ± Rifampicin

33
Q

Methods of preventing HIV

A

Reduce vertical transmission

Behavioural: sex-ed, condoms

34
Q

HIV Tx

  • therapy name
  • how it works
  • how many
A

HAART (highly active antiretroviral therapy)

Inhibit enzymes involved in RNA reverse transcription, HIV cell fusion etc

Use at least 3 antiretrovirals

35
Q

How antiretrovirals work

A

Prevent DNA chain forming from RNA

Block viral reverse transcriptase

Block cleavage of active proteins to form virions

Block entering CD4

36
Q

Post-Exposure prophylaxis HIV

A

4 week course Tenofovir + Emtricitabine + Raltegravir

Given 1hr –> 3 day from needlestick (0.3-0.5% transmission risk for needlestick)

37
Q

E.g. of antiretrovirals

just to see

A

Tenofovir Emtricitabine Raltegravir
Enfurvitide
Ritonavir

38
Q

What HAART compliance is needed?

A

a 95% compliance is needed for good response

39
Q

Vertical HIV transmission

  • methods
  • risk %
  • prev
A

From delivery or breast milk

25-40% risk

HAART to mother form end of T1

C-section unless viral load less than 50

Post-natal infant zidovudine mono therapy for 4w (takes risk to 1%)

40
Q

Viral haemorrhage fevers:

  • Filovirus e.g.
  • Flavivirus e.g.
A

Ebola

Zika, Yellow fever

Notifiable diseases

41
Q

Ebola

  • where from
  • mech
A

Bats

Work by inc vascular permeability.
Causes mucous membrane haemorrhage, hypovolaemia, shock and circulatory collapse

42
Q

Viral haemorrhage fever Pres

A

Overseas travel to affected area

Flu-like symptoms: temp, sore throat, headache, myalgia, N&V

Maculopapular/petechial rash, hypotension, mucus membrane haemorrhage

43
Q

Viral haemorrhage fever investigations

A

LFT: elevated transaminases

FBC: leukopenia, thrombocytopenis

Coal: PTT and INR prolonged

DIC: D-dimer high, fibrinogen low

44
Q

Amoebic liver disease

  • organism
  • pres
  • Ix
  • Tx
A

Entamoeba histolytica (tropical illness_

Fever. RUQ pain (Referred to R shoulder), Wt loss

signs: hepatomeg, pallor, jaundice

Stool antigen, serum antibody, Liver USS

Metronidazole ± aspiration

45
Q 
Giardia
- Transmission
- Pres
- Ix
Tx
A

Oral ingest (tap water, salads mainly)

diarrhoea (weeks), burping, abdo bloating and pain

Stool microscopy (trophozoites), ELISA stool antigen test

Metronidazole

46
Q

Typhoid

  • organism
  • trans
  • pathophys
A

Salmonella typhi

Faeco-oral (food/water)

Adhesion & invasion through gut wall, spread through reticuloendothelial system (spleen, BM)

47
Q

Typhoid

  • pres
  • Ix
  • Tx
  • complications
A

Fever, frontal headache, malaise, Prostration (very weak)

FBC, LFT (transaminase high), blood/stool/BM culture may show

Ceftriaxone or azithromycin
Fluids
Antipyretics (para)

Chronic carriage (biliary, hepatic), bowel perforation

48
Q

Dengue

  • Spread
  • Pres
A

Mosquito

Fever, rash, flushing, haemorrhage fever, (DIC, hepatomegaly, pleuritic effusion, circulatory collapse)

LFT: transaminase high, albumin low (leaky vessels), IgM +ve serology

Oral//IV fluids, antipyretics, NOTIFICATIONS

49
Q

Schistosomiasis

  • Pathology
  • Sympt
  • Ix
  • complication
A

Eggs in bladder. haematologinous spread to liver = chronic liver disease

fever, abdo pain, haematuria

Urine microscopy - direct visualisation of eggs

Bladder cancer (from chronic inflammation)

50
Q

Chlamydia

  • Type of organism
  • Sympt
  • Ix
  • Tx
A

Obligate intracellular

Dysuria, discharge

First catch urine, nucleic acid amplification testing

Contact tracing, Azithromycin (single oral), Doxy

51
Q

Gonorrhoea

  • Type of organism
  • Sympt
  • Ix
  • Tx
A

Gram -ve diplococci

Dysuria, purulent discharge

nucleic acid amplification testing, gram stain

Contact tracing,
IM ceftriaxone, Azithromycin

52
Q

Thrush

  • Type of organism
  • Sympt
  • Tx
A

Candida

White curds, Itch

Fluconazole

53
Q

Syphilis

  • Organism
  • Pres (primary, secondary, tertiary)
A

Spirochete - Treponema pallidum

Primary: local papule / ulcer (Chancre), lymphadenopathy
Secondary: rash on plasma, soles, trunk, alopecia
Teritary: end organ complication after years of infection (dementia, ataxia, aortic regurgitation (diastolic murmur)

54
Q

Syphilis

  • Ix
  • Tx
A

Swab and microscopy
LP/CSF analysis
CXR + ECHO (aortic regurgitation)

IM benzylpenicillin + Prednisolone

55
Q

Syphilis prognosis

A

65% no sequelae
10% neurosyphilis (doral column degen - paralysis, dementia) at 10 years
10% CV syphilis at 20 years

56
Q

Malaria

  • What is
  • Where
  • Types
A

Plasmodium parasitic infection

90% cases/deaths in Sub-Saharan Africa

Falciparum (most dangerous, Africa/SE Asia)
Vivax, Ovale, Malariae, Knowlesi

57
Q

Malaria RF

A

Endemic area, no chemoprophylaxis, no physical barriers (bed net)
Preg
Immunocompromised
Olde

58
Q

Who protected against Malaria

A

G6PD

Sickle cell

59
Q

Which cells affected in malaria

A

Erythrocytes
Liver

Parasite divides in cells until cells rupture and spill out parasite to infect other cells

60
Q

Problem with malaria Prev/Tx

A

Resistance is a problem

61
Q

Prevention Falciparum

A

Chloroquine sensitive: Chloroquine, hydroxychloroquine (1w prior, 4w after)

Resistant: Doxy (1-2 days prior, 4w after)

62
Q

Primary prevention Malaria

A 
Avoid outdoor after sunset
Insect repellent
Long sleeves
Insecticide treated bed nets
Antimalarial chemoprophylaxis
63
Q

Malaria Symptoms

A 
Fever (chills, rigors)
Headache
weakness
Myalgia
Arthralgia
Anorexia
Diarrhoea
Jaundice
Tachycardia & Hypotension
Hepatosplenomegaly
64
Q

Malaria investigation

A

Giemsa stained thick and thin blood films (parasites within RBC)

Thick film for parasite number
Thin film for species

65
Q

Tx Falciparum

A

Chloroquine or hydroxychloroquine

If resistant:
Quinine + Doxy
OR
Artemether + Lumefantrine

66
Q

Malaria complications

A

Acute renal failure (dehydration)
Hypoglycaemia
Metabolic acidosis (tissue hypoxia from anaemia and hypovolaemia
Seizure (acidosis, hypoglycaemia)

67
Q

If a Q mentions Caves or Bats …

A

Viral haemorrhage fever
Rabies
Histoplasmosis

68
Q

MRSA

  • Resistance to
  • What to use
A

Methicillin resistant Staph aureus

Methicillin is precursor of Flucloxqcillin (resist to beta lactams - penicillin, cephalosporins)

Vancomycin or Teicoplanin

69
Q

C.Diff

  • Causes
  • Tx
A 
The C's
-Ciprofloxacin
Co-amoxiclav
Carbapenems
Clindamycin (the worst)
Cephalosporins

STOP OFFENDING ABx
Metronidazole, Vancomycin for sev

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