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Phase 3B > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

Name six gram positive bacteria.

A 
Staphylococcus (including aureus, epidermis, viridans)
Strep pneumoniae
Strep pyogenes
Strep viridans
Diphtheria
C.difficile
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2
Q

Name eight gram negative bacteria.

A 
Bordetella pertussis
Escherichia coli, shigella, salmonella
Haemophilus influenzae
Vibrio cholerae
Legionella pneumoniae
Heliobacter pylori
Chlamydia
Neisseria
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3
Q

What are the six subtypes of E.coli infection?

A 
Enterotoxigenic (traveller's diarrhoea)
Enteropathogenic
Enterohaemorrhagic
Enterioinvasive
Enteroaggregative
Uropathogenic
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4
Q

What type of bacteria is Neisseria?

A

Gram negative non-flagellated diplococci

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5
Q

What is primary complex TB?

A

Granuloma + inflammation in the lymphatics and lymph nodes

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6
Q

What are three risk factors for tuberculosis?

A

HIV
Malnutrition
CKD

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7
Q

What type of bacteria causes tuberculosis?

A

Acid-fast aerobic mycobacteria

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8
Q

What are the pulmonary symptoms of tuberculosis?

A

Productive cough + haemoptysis
Weight loss, fever, sweats
Hoarse voice
Pleuritic pain

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9
Q

What does CXR show in a patient with tuberculosis?

A

Consolidation
Cavitation
Pleural effusion
Thickening/widening of mediastinum

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10
Q

Which nodes are infected in TB following pulmonary infection?

A

Extrathoracic
Cervical
Supraclavicular

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11
Q

Which patients with TB develop GI symptoms?

A

Immunocompromised

Ethnic minorities

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12
Q

What can develop after typical TB infection?

A 
Bone/spine involvement
Tuberculus meningism
Tuberculus peritonitis
Pericardial TB
Miliary TB
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13
Q

What stain is used to rapidly identify TB mycobacteria in a sample?

A

Auramine-phenol

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14
Q

How is TB diagnosed?

A

Sample culture

PCR: rapid and sensitive. Confirms species e.g. TB v non-tuberculus mycobacteria

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15
Q

What is the treatment of TB?

A

2 months isoniazid, ethambutol, rifampicin, pyrazinamide

4 months isoniazid and rifampicin

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16
Q

What is the treatment of latent TB?

A

6 months isoniazid or 3 months isoniazid and rifampicin

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17
Q

What are the side effects of rifampicin and isoniazid?

A

Rifampicin - oral contraceptive not effective. Stains body secretions pink
Isoniazid - polyneuropathy

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18
Q

What are the side effects of ethambutol and pyrazinamide?

A

Ethambutol - optic retrobulbar neuritis

Pyrazinamide - hepatic toxicity

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19
Q

How is latent TB diagnosed?

A

Tuberculin skin test shows a raised indurated lesion (delayed hypersensitivity reaction)

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20
Q

What is multidrug resistant TB?

A

TB that is at least resistant to isoniazid and rifampicin

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21
Q

How is contact screening performed for a TB patient?

A

Mantoux test

Quantiferon/Elispot - interferon gamma release assay (IGRA)

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22
Q

What colour is sputum in pneumococcal pneumonia?

A

Rusty

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23
Q

What are three signs of pneumonia on examination?

A

Lung consolidation on percussion and auscultation
Crackles +/- wheeze
Bronchial breathing

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24
Q

What score is used to grade severity of pneumonia?

A

CURB-65

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25
Q

What is the treatment of mild, moderate, and severe pneumonia?

A

Mild - PO amoxicillin (macrolide/tetracycline if allergic)
Mod - PO amoxicillin + macrolide
Severe - IV co-amoxiclav/cefuroxime + macrolide

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26
Q

Give three examples of macrolide antibiotics.

A

Erythromycin
Clarithromycin
Azithromycin

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27
Q

What are the signs of empyema?

A

Pleuritic pain

Signs of pleural collection - dull to percussion and decreased air entry

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28
Q

Thoracocentesis of empyema shows what?

A

pH<7.2
Glucose <3.3mmol/L
Pus
LDH>1000iu

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29
Q

How is hepatitis B transmitted?

A

Vertical transmission - during parturition or soon after

Horizontal transmission - close contact, sharps, sexual

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30
Q

What is the presentation of acute hepatitis B infection?

A

Subclinical usually
Fever, jaundice, rash, arthralgia
Extra-hepatic manifestations - PAN or glomerulonephritis

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31
Q

What is the function of the following antigens and antibodies?

1) HBsAg and HBsAb
2) HBeAg and HBeAb

A

1) Surface antigen = infection
Surface antibody = immunity
2) Envelope antigen = assess phase of infection Envelope antibody = evidence of immune response as appears in the later phase of acute or chronic disease.

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32
Q

What is the function of HBV DNA?

A

Quantified by PCR, helps determine viral activity

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33
Q

What is the function of HBcAb (core antibody)?

A

Identifies exposure - previous, current, chronic etc

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34
Q

How is Hepatitis B usually managed?

A

Usually none, or supportive

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35
Q

What percentage of Hepatitis B patients do not clear the virus?

A

1-10% - they develop chronic infection and fulminant hepatitis

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36
Q

What patient groups are more at risk of developing chronic hepatitis B infection?

A

Neonates

Child below 5 years

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37
Q

How is chronic hepatitis B diagnosed?

A

Moderate rise in aminotransferases and ALP
Ground glass appearance of liver
HBsAg and HBcAb found

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38
Q

What is required for Hepatitis D to replicate?

A

Hepatitis B

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39
Q

How is chronic Hepatitis B managed?

A

48 weeks PEGylated alpha-2alpha interferon

Entacavir or tenofovir disoproxil - more likely this as less side effects

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40
Q

In chronic hepatitis B infection, what is a marker of fulminant hepatitis?

A

Increasing INR

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41
Q

How is hepatitis C transmitted?

A

Blood/blood products - parenteral

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42
Q

What is the presentation of acute hepatitis C?

A

Flu-like illness

Jaundice and RUQ pain

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43
Q

What percentage of patients with acute hepatitis C develop chronic disease and end stage liver disease?

A

66%

33% in first 25 years

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44
Q

What suggests a patient is less likely to clear the virus and will progress to end stage liver disease?

A

They are asymptomatic in the acute stage.
Co-existing hepatic pathology
HIV
African American

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45
Q

What are the extra-hepatic manifestations of hepatitis C?

A

Essential mixed cryoglobulinaemia
Membranoproliferative glomerulonephritis
Porphyria cutanea tarda
Autoimmune thyroid disease

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46
Q

How is hepatitis C diagnosed?

A

Enzyme immunoassay
Immunoblot assay for HCV antibody
PCR for HCV RNA

47
Q

How is liver fibrosis assessed in chronic hepatitis C?

A

Assessment of transient liver elastography: Fibroscan

48
Q

What are the details of hepatocellular carcinoma screening in patients with advanced fibrosis or cirrhosis?

A

6 monthly alpha-FP

Liver USS

49
Q

The aim of Hepatitis C treatment is to cure. Define cure:

A

Undetectable HCV RNA in blood 12 weeks post treatment (suggests a sustained virological response)

50
Q

What is the treatment of Hepatitis C?

A

2+ Direct-Acting Antivirals (DAAs) for 8-16 weeks

May have the addition of ribavarin

51
Q

Give an example of DAAs for Hepatitis C?

A

Harvoni: ledipasvir (NS5A inhibitor) and sofosbuvir (NS5B inhibitor)

52
Q

In pregnant patients with HIV, what value of viral load makes vaginal delivery a possibility?

A

Undetectable viral load

53
Q

What are three risk factors for HIV?

A

Multiple sexual partners
Sharing needles
MSM

54
Q

What may be the first presentation of HIV?

A

Generalised lymphadenopathy
Acute generalised rash on palms and soles
Oral candida/herpes simplex
Recently developed seborrheic dermatitis/psoriasis
Odd looking mouth lesions

55
Q

How is HIV tested for?

A

Venous blood sample - HIV antibodies are detected in serum 4 weeks post exposure

56
Q

What are the three phases of HIV?

A

1) Acute primary infection
2i) Asymptomatic phase
2ii) Early symptomatic HIV
3) AIDS

57
Q

Define AIDS.

A

CD4+ count <200 or presence of an AIDs defining illness

58
Q

What viral load suggests uncontrolled HIV?

A

> 500,000 copies

59
Q

What are the main risks once CD4+ count falls below 50?

A

Mycobacterium avium intracellulare (MAI)

CMV

60
Q

Where does the HIV virus replicate?

A

Genital tract
CNS
Bone marrow
GI tract

61
Q

Name two bacterial AIDS-defining conditions in adults.

A

Mycobacterium tuberculosis

MAI

62
Q

Name two viral AIDS-defining conditions in adults.

A

CMV other than liver, spleen, or nodes

HSV chronic ulcer >1m or bronchitis, pneumonitis, or oesophagitis

63
Q

Name three other AIDS-defining conditions.

A

Candidiasis of bronchi, lungs, or oesophagus
Histoplasmosis
Toxoplasmosis of brain
PCP - fungal

64
Q

Name three AIDS-defining malignancies.

A

Cervical carcinoma
Burkitt’s lymphoma
Kaposi’s sarcoma

65
Q

What are three side effects of HAART?

A

Lipodystrophy
Lactic acidosis
Insulin resistance

66
Q

Define persistent generalised lymphadenopathy.

A

Enlarged lymph nodes involving at least 2 non-contingous sites other than inguinal nodes.

67
Q

Name six conditions that may present during the early symptomatic HIV (Phase 2ii).

A 
Oral hair leukoplakia
Varicella zoster virus >2 episodes
Cervical dysplasia
Bacillary angiomatosis
Pelvic inflammatory disease
ITP
68
Q

Which virus is oral hair leukoplakia associated with?

69
Q

What type of retinitis can be seen in HIV?

A

CMV

Toxoplasma

70
Q

What is the most common combination of HAART drugs for treatment of HIV, and give an example?

A

NRTI backbone (2NRTIs) plus one of:

  • Integrase inhibitor
  • NNRTI
  • Protease inhibitor

E.g. tenofovir+emtricitabine PLUS raltegravir

71
Q

What is a NRTI and give an example.

A

Nucleoside reverse transcriptase inhibitor

Abacavir

72
Q

What is post-exposure prophylaxis?

A

4 week HAART treatment given to patients who are HIV seronegative but have had a high risk exposure

73
Q

Which antibiotic is given as prophylaxis against PCP pneumonia?

A

Co-trimoxazole

74
Q

What is the name given to the malaria parasite when inside the mosquito, inside the liver, and inside RBC?

A

Mosquito: sporozoites
Liver: merozoites
RBC: gametocytes

75
Q

How does a virus evade host defence mechanisms?

A

Antigenic variability
Prevention of host cell apoptosis
Down regulation of interferon production

76
Q

What is the function of complement proteins in the humoral immune response?

A

Opsonisation and lysis

77
Q

How does a bacterium evade host defence mechanisms?

A

Secrete proteases that lyse IgA
Polysaccharide capsule prevents phagocytosis
Antigenic variation
Secretion of elastase inhibits C3a and C5a

78
Q

What are the symptoms of Dengue fever?

A

Fever
Headache
Severe MSK pain
Rash

79
Q

What is the aetiology of Dengue fever?

A

RNA flavivirus using aedes mosquito as a vector

80
Q

Name two transmissible haemorrhagic viruses.

A

Ebola

Lassa fever

81
Q

What are the two types of trypanosomiasis?

A

South American - Chagas disease

African - Tsetze fly

82
Q

How is malaria transmitted?

A

The bite of the female anopheles mosquito that is infected with plasmodia spp

83
Q

Following a bite, what is the pathogenesis of malaria?

A

Merozoites are released into the bloodstream and infect red blood cells every 72 hours

84
Q

What are the symptoms of malaria?

A

Fever, sweats, headache, fatigue, myalgia
Nausea, vomiting, diarrhoea
Anaemia, jaundice, hepatosplenomegaly
Dark urine

85
Q

How is malaria diagnosed?

A

Mildly raised ALT/AST
Low platelets and anaemia, low glucose
Hyperbilirubinaemia
Thick and thin blood films identify species
Blood cultures
MSU, CXR, stool culture for ovum, parasites, cysts

86
Q

What are the signs and symptoms of cerebral malaria?

A

Increased ICP and shock
Hypoglycaemia and coma
Convulsions
ARDS

87
Q

Why are malaria patients hypoglycaemic?

A

The parasite utilises glucose.

88
Q

What is the treatment of non-falciparum malaria?

A

Chloroquine OR

Artemisinin based combination therapy (ACT) - includes artesunate and amodiaquine

89
Q

What is the treatment of uncomplicated falciparum malaria?

A

Artemisinin based combination therapy (ACT) - artesunate and amodiaquine

90
Q

What is the treatment of complicated falciparum malaria?

A

IV artesunate

91
Q

What is the treatment of toxoplasma?

A

Sulfadiazine and pyrimethamine

92
Q

What is the treatment of amoebiasis?

A

Metronidazole

93
Q

What is the treatment of trypanosomiasis?

A

Pentamidine

94
Q

What is the treatment of giardiasis?

A

Metronidazole

95
Q

What is the treatment of schistosomiasis?

A

Praziquantel

96
Q

What is the treatment of pinworms/threadworms?

A

Mebendazole or pyrantel

97
Q

Give five causes of drug induced fever?

A 
Malignant hyperthermia from general anaesthetic
Lamotrigine/progesterone
Neuroleptic malignant syndrome
Serotonin syndrome
Cocaine
98
Q

What is the cause of malignant hyperthermia?

A

AD inherited myopathy due to ryanodine receptor gene on chromosome 19

99
Q

What are five symptoms and signs of malignant hyperthermia?

A 
Tachycardia
Hypoxia and hypercapnia
Fever
Muscular rigidity
Hypotension
100
Q

How is malignant hyperthermia managed?

A 
Give 100% oxygen
Deepen anaesthesia with opioids
IV dantrolene
Correct blood gases and arrhythmias
Cool patient
101
Q

Which antibiotic is recommended to treat invasive (bloody) diarrhoea?

A

Ciprofloxacin

102
Q

How do you monitor the response to treatment of a malaria patient?

A

Parasite count

103
Q

What must you check for before initiating anti-malarials?

A

Glucose 6-phosphate dehydrogenase deficiency

104
Q

Name the most common anti-malarial drug.

A

Malarone - atovaquone and proguanil

105
Q

What is seen in legionella pneumonia?

A

Hyponatraemia

Increased transaminases

106
Q

What does mucous in the stool suggest?

A

Malabsorption/giardia

107
Q

How is PCP pneumonia diagnosed?

A

Sputum sample for detection of the fungus using silver staining of the cyst wall. If no sputum can be aspirated then broncholavage for deep lung tissue
High resolution CT

108
Q

What is the most common cause of infective endocarditis?

A

S.aureus/strep.viridans

109
Q

How do you differentiate between staph and strep with the catalase test?

A

Staph: catalase positive
Strep: catalase negative

110
Q

How do you differentiate staph aureus from other types of staph?

A

Staph aureus: coagulase positive

Staph epidermis: coagulase negative

111
Q

What is the treatment of c.difficile?

A

Metronidazole or vancomycin

112
Q

What are three risk factors for development of c.difficile?

A

Clindamycin/penicillin
PPIs
Increasing age

113
Q

How does Parvovirus B19 infection present in children and adults?

A

Children - slapped cheek rash

Adults - lacy macular widespread rash, rheumatoid-like arthritis

Phase 3B (20 decks)

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