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3b specialties > Infectious diseases > Flashcards

Infectious diseases Flashcards

1
Q

What are some causes of atypical pneumonia?

A

legionella pneumophilia
Mycoplasma pneumonia
Chlamydia

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2
Q

What are causes of atypical pneumonia in HIV patients?

A

Aspergillus

Pneumocystis jiroveci

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3
Q

What are causes of atypical pneumonia in CF patients?

A

Pseudomonas

Burkholderia

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4
Q

How are atypical pneumonias treated?

A

Clarithromycin

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5
Q

What are causes of typical pneumonia

A

strep pneumoniae
h. influenzae
staph aureus
klebsiella pneumoniae

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6
Q

how is typical pneumonia treated?

A

amoxicillin if mild

co-amoxiclav and macrolide e.g. erythromycin if moderate or severe

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7
Q

what type of organism is strep pneumoniae?

A

gram positive diplococcus

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8
Q

when is staph aureus pneumonia common?

A

post influenza

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9
Q

what makes up a bacterial cell wall?

A

peptidoglycan

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10
Q

what electrolyte imbalance does legionella pneumophiliacause?

A

low sodium

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11
Q

what is the motor response in GCS?

A
  1. Obeys commands
  2. Localises to pain
  3. Withdraws from pain
  4. Abnormal flexion to pain (decorticate posture)
  5. Extending to pain
  6. None
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12
Q

what is the verbal response in GCS?

A
  1. Orientated
  2. Confused
  3. Words
  4. Sounds
  5. None
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13
Q

what is the eye response in GCS?

A
  1. Spontaneous
  2. To speech
  3. To pain
  4. None
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14
Q

what investigation needs to be done if you suspect legionella pneumonia?

A

urinary antigens
sputum culture and PCR for chlamydia or mycoplasma differential
CXR

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15
Q

what are the potential complications of legionella pneumonia?

A 
sepsis
hyponatraemia
renal failure
pleural effusion
abscesses
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16
Q

what is legionella pneumonia associated with?

A

colonises water tanks e.g. holidays/air con

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17
Q

what drug should be given before results of urinary antigens come back in atypical pneumonia?

A

tazocin

tx of legionella is erythromycin/clarithromycin but give broad spec before confirmation

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18
Q

Ix in meningitis?

A 
full blood count
CRP
coagulation screen
blood culture
whole-blood PCR
blood glucose
blood gas
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19
Q

immediate management if meningococcal septicaemia suspected?

A

IM benzylpenicillin

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20
Q

what is initial empirical therapy aged > 50 years for meningococcal septicaemia?

A

Intravenous cefotaxime + amoxicillin

amoxicillin is for listeria cover, only if >50

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21
Q

what is meds used for meningitis caused by listeria?

A

Intravenous amoxicillin + gentamicin

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22
Q

what is the treatment of meningitis if penicillin allergic?

A

chloramphenicol

if amoxicillin allergic- cotrimoxazole

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23
Q

what is also given in meningitis to reduce neurological sequale?

A

dexamethasone

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24
Q

what is the rash expected in meningococcal septicaemia?

A

non-blanching purpura

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25
Q

when couldn’t you do a LP?

A

raised ICP

don’t need to do if the patient has a rash

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26
Q

name some bacterial causes of meningitis? (>6 years)

A 
Neisseria meningitidis (meningococcus)
Streptococcus pneumoniae (pneumococcus)
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27
Q

name some bacterial causes of meningitis in neonates to 3 months?

A

Group B Streptococcus: usually acquired from the mother at birth. More common in low birth weight babies and following prolonged rupture of the membranes
E. coli and other Gram -ve organisms
Listeria monocytogenes

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28
Q

name some bacterial causes of meningitis in 3 months to 6 years?

A 
Neisseria meningitidis (meningococcus)
Streptococcus pneumoniae (pneumococcus)
Haemophilus influenzae
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29
Q

what are classic signs and symptoms of meningitis?

A 
headache
fever
nausea/vomiting
photophobia
drowsiness
seizures

Signs:
neck stiffness
purpuric rash

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30
Q

what are the CSF finding in bacterial meningitis?

A

cloudy
high protein
low glucose
10 - 5,000 polymorphs/mm³

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31
Q

what are the CSF finding in viral meningitis?

A

clear
normal/raised protein
high glucose
lymphocytes

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32
Q

what are the CSF findings in TB meningitis?

A

slightly cloudy
high protein
low glucose
lymphocytes

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33
Q

who needs to informed if a diagnosis of bacterial meningitis?

A

Public health england

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34
Q

name some viral causes of meningitis?

A

Viral enterococcus

HSV

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35
Q

what is prophylaxis of close contacts of meningitis?

A

ciprofloxacin (recommended)or rifampicin

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36
Q

name the species of malaria?

A

P.falciparum (most common and severe)
P.vivax
P.ovale
P.malariae

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37
Q

how is malaria transmitted?

A

by the bite of the female anopheline mosquito

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38
Q

what are the features of malaria?

A 
severe headache
fever/ cold/ sweating
splenomegaly
dry cough
myalgia
D&V
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39
Q

what is a protective factor for malaria?

A

sickle cell trait (HbS)

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40
Q

Ix for malaria

A 
3 x thick and thin blood films
(thick= diagnostic)
(thin= species)
bloods inc coag screen and LFTs
RDT (antigen test)
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41
Q

mx of falciparum malaria?

A

most are resistant to chloroquine

  • IV artesunate if severe
  • ACTS if uncomplicated
  • fluids and ITU support
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42
Q

mx of other strains of malaria?

A

quinine

artemisinin-based combination therapy (ACT) or chloroquine

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43
Q

complications of severe malaria?

A 
DIC
multi-organ failure
seizures and coma
death
ARDS
shock
sepsis
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44
Q

malarial prophylaxis drugs?

A

doxycycline- 2 weeks prior and 4 weeks after
malarone- 2 days before and 7 days after
methequine- taken weekly

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45
Q

SEs of doxycycline?

A

sunlight hypersensitivity, nausea and diarrhoea

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46
Q

SEs of methequine?

A

neuropsychiatric SEs- anxiety and hallucinations

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47
Q

common causes of gastroenteritis?

A

Viral- Rotavirus
Norovirus
Adenovirus

Bacterial- E.coli, Campylobacter jejuni, shigella, salmonella, bacillus cereus, giardia, staph aureus

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48
Q

what are the 4C’s that are associated with C.diff infection?

A

clindamycin, cephalosporins, co‐amoxiclav and ciprofloxacin

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49
Q

what condition can C.diff infection lead to?

A

pseudomembranous colitis

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50
Q

features of C. diff infection?

A

diarrhoea
abdominal pain
a raised white blood cell count is characteristic
if severe toxic megacolon may develop

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51
Q

diagnosis of C.diff

A

is made by detecting Clostridium difficile toxin (CDT) in the stool

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52
Q

mx of C.diff

A

1st line- metronidazole

2nd line- vancomycin

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53
Q

features of E.coli infection?

A 
most common cause of GE
travellers
watery stools
abdo pains
nausea
It is spread through contact with infected faeces, unwashed salads or water.
E. coli 0157 produces the Shiga toxin- can lead to haemolytic uraemic syndrome
no ABX tx
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54
Q

features of giardia infection?

A

prolonged, non bloody diarrhoea

tx= metronidazole

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55
Q

features of cholera?

A

profuse, watery diarrhoea
hypoglycaemia
severe dehydration resulting in weight loss
travellers

56
Q

features of shigella infection?

A

bloody diarrhoea
vomiting and abdo pain
Shigella is spread by faeces contaminating drinking water, swimming pools and food.
Shigella can produce the Shiga toxin and cause haemolytic uraemic syndrome. Treatment of severe cases is with azithromycin or ciprofloxacin.

57
Q

features of campylobacter infection?

A

flu-like prodrome followed by crampy abdo pains, fever and diarrhoea which may be bloody
may mimic appendicitis

It is spread by:
Raw or improperly cooked poultry
Untreated water
Unpasteurised milk

58
Q

what typically causes bacillus cereus infection?

A

rice

59
Q

features of amoebiasis infection?

A

gradual onset bloody diarrhoea

abdo pain and tenderness which may last for several weeks

60
Q

mx of campylobacter?

A

Clarithromycin

61
Q

mx of salmonella and shigella

A

ciprofloxacin

62
Q

what else needs to be done with infective GE?

A

The ‘Proper Officer’ at the Local Health Protection Team needs to be notified. They in turn will notify the Health Protection Agency on a weekly basis

63
Q

how to tell if cellulitis has progressed to necrotising fasciitis?

A

pain disproportionate to injury

64
Q

Ix for cellulitis?

A

bacterial= black swabs

blood cultures

65
Q

what is HIV?

A

a single stranded RNA virus

causes host cells to produce virions which infect new cells with CD4 receptor

66
Q

transmission of HIV?

A 
needlestick
sex
IVDU
blood products
vertical transmission
67
Q

diagnosis of HIV?

A

serology
detect antibodies and antigens of the virus

(can have false negative results up to 4 weeks post infection)

68
Q

markers of disease progression in HIV?

A

CD4 cells

viral load

69
Q

what does U=U mean?

A

undetectable viral load= untransmittable

70
Q

what is at risk once CD4 count <200?

A

opportunistic infections e.g. PCP and toxoplasmosis

71
Q

what is at risk once CD4 count <50?

A

MAI- mycobacterium avium intracellulare

CMV

72
Q

when is AIDS diagnosed?

A

CD4 count <200

73
Q

what are AIDs defining illnesses?

A 
Kaposi’s sarcoma
Pneumocystis jirovecii pneumonia (PCP)
Cytomegalovirus infection
Candidiasis (oesophageal or bronchial)
Lymphomas
Tuberculosis
74
Q

Ix of PCP?

A

CD4 count and viral load
CXR
bronchio-alveolar lavage
sputum culture

75
Q

TX of PCP?

A 
IV cotrimoxazole (oral when well) for 21 days
steroids
76
Q

tx of HIV?

A

antiretroviral therapy-

2NRTIs plus PI or NNRTI

77
Q

what is post-exposure prophylaxis for HIV?

A

zidovudine- within 72 hours of exposure

do pregnancy test before

78
Q

prophylaxis of CMV?

A

gancyclovir

79
Q

prophylaxis of PCP?

A

co-trimoxazole

80
Q

differentials of jaundice in the UK?

A 
hepatitis
EBV
CMV
ascending cholangitis
typhoid
TB
malaria
leptospirosis
81
Q

transmission of hep A?

A

faco-oral transmission (shellfish)

82
Q

features of hep A?

A

Acute
self-limiting jaundice and abdo pain
IgM

83
Q

tx of hep A

A

supportive vaccine

84
Q

RFs of hep B?

A 
IVDU
multiple sexual partners
blood products
vertical transmission
typically prisons, homeless, overcrowding
85
Q

features of hep B?

A

acute- jaundice, malaise, abdo pain, N&V

86
Q

Ix of hep B?

A

various antibodies
PCR for viral load
LFTs- high bilirubin, high ALT/AST, high ALP
histology- ground glass hepatocytes

87
Q

signs of previous vaccination

A

HBsAb

88
Q

signs of chronic infection

A

HBcAb, HBs Ag, HBV-DNA

89
Q

signs of infection cleared after exposure

A

HBsAb, HBcAb

90
Q

tx of Hep B infection?

A

Screen for other blood born viruses (hepatitis A and B and HIV) and other sexually transmitted diseases
Refer to gastroenterology, hepatology or infectious diseases for specialist management
Notify Public Health (it is a notifiable disease)
Stop smoking and alcohol
Education about reducing transmission and informing potential at risk contacts
Testing for complications: FibroScan for cirrhosis and ultrasound for hepatocellular carcinoma
Antiviral medication- tenofevir or entecavir
Liver transplantation for end-stage liver disease

91
Q

prognosis of Heb B?

A

80% full recovery
10% chronic hepatitis
10% carriers

92
Q

what to use as prophylaxis for transmission

A

HBIG

give within 24 hours of birth if vertical, followed by full vaccination course

93
Q

transmission of Hep C?

A

blood products and sexually
IVDU most common
toothbrushes and razors

94
Q

features of Hep C?

A

majority are asymptomatic

10-15% have jaundice and other general symptoms

95
Q

who needs to be screened for hep C?

A

any patient with a persistently elevated ALT

96
Q

diagnosis of hep C?

A 
serology- HCV antibody
PCR- HCV PCR
LFTs
FBC
U&amp;Es
97
Q

clinical assessment of the liver?

A

Fibroscan- assesses liver stiffness
if advanced fibrosis- 6 monthly AFP and liver USS for screening of HCC
OGD if gastric or oesophageal varices

98
Q

features of liver failure?

A

coagulopathy- prolonged PT time
splenomegaly
varices

99
Q

tx of hep C virus?

A

DAAs- direct acting antiviral drugs

monitor FBC, U&E and LFTs every 4 weeks and viral load

100
Q

what is defined as cure for Hep C?

A

undetectable HCV RNA in the blood 12 weeks after the end of treatment

101
Q

RFs for TB?

A 
HIV
overcrowding
IVDU
ethnic minorities
homeless
immunosuppression
102
Q

what is the pathophysiology of TB?

A

mycobacterium tuberculosis -> engulfed by macrophages -> form granumoas -> GHON focus -> latent phase -> MTB enters bloodstream-> extra-pulmonary TB

103
Q

features of TB?

A

pulmonary- cough +/- haemoptysis
SOB

fever, night sweats, weight loss, fatigue, lymphadenopathy

extra pulmonary- TB meningitis, pericarditis, arthritis etc (anywhere in body)

104
Q

test for latent TB?

A

Mantoux

quantiferon gold test

105
Q

test for active TB?

A

CXR

sputum microscopy for acid fast bacilli (Ziehl-Neelson stain)

106
Q

Tx of TB and tests to do beforehand?

A

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

U&Es, LFTs, FBC, vision testing

107
Q

SE of rifampicin?

A

nausea, anorexia, red urine, hepatotoxicity

108
Q

SE isoniazid?

A

N&V, constipation, peripheral neuropathy

109
Q

SE pyrazinamide?

A

hepatoxicity, N&V, arthralgia, sideroblastic anaemia

increased uricaemia causing gout

110
Q

SE ethambutol?

A

optic neuritis

111
Q

prevention of TB?

A

notifiable disease
prophylaxis of contacts
BCG vaccine

112
Q

what is infectious mononucleosis?

A

glandular fever

113
Q

causes of glandular fever?

A

EBC
CMV
HHV-6

114
Q

features in glandular fever?

A

sore throat, pyrexia and lymphadenopathy

also splenomegaly, hepaitis

115
Q

diagnosis of glandular fever?

A

monospot test and FBC

116
Q

how long do you have to avoid playing contact sports in glandular fever?

A

8 weeks

117
Q

cause of syphilis?

A

spirochaete e.g. treponema pallidum

118
Q

primary features of syphilis?

A

chancre- painless ulcer at site of sexual contact

local non-tender lymphadenopathy

119
Q

secondary infection in syphilis?

A 
6-10 weeks after primary infection
fevers, lymphadenopathy
rash on trunk, palms and soles
buccal ulcers
condylomata lata
120
Q

tertiary features of syphilis?

A

gummas
ascending aortic aneurysms
Argyll Robertson pupil
tabes dorsalis

121
Q

Ix of syphilis?

A 
rological tests can be divided into:
cardiolipin tests (not treponeme specific) e.g. VDLR
treponemal-specific antibody tests
122
Q

tx of syphilis?

A

benzathine penicillin 1st line IM

alternative- doxycycline

123
Q

what rash is sometimes seen following syphilis tx?

A

Jarisch-herxheimer

124
Q

what disease is common in warm fresh water in the tropics? e.g. canoeing/sailing holidays

A

leptospirosis, leptospira interrogans

tx= doxycycline

125
Q

complication of leptospirosis?

A

Weil’s disease- jaundice occurs about 1 week after the onset of symptoms
causes renal failure and major haemorrhage

126
Q

characteristics of lyme disease and cause?

A

tick bite
target-shaped rash, an erythematous macule spreads slowly from the centre
can have joint involvement with a mono- or oligoarthritis

127
Q

how to diagnose PCP?

A

bronchoalveolar lavage
CXR- bilateral perihilar shadowing
Cysts and trophozoites on microscopy of the sputum
Exercise induced desaturations

128
Q

tx of PCP?

A

Co-trimoxazole

+ steroids if hypoxic

129
Q

neurocomplications of HIV/

A

Cerebral toxoplasmosis - tx is sulfadiazine
Cryptococcus meningitis
Primary CNS lymphoma
NHL
CMV encephalitis
Progressive multifocal leukoencephalopathy

130
Q

Ix of viral hepatitis?

A 
LFTs and clotting
Hep B and C serology
Alpha fetoprotein
US scan  of the liver
Liver biopsy
131
Q

what 2 STIs can present with a chancre?

A

syphilis

gonorrhoea

132
Q

girl comes back from India with rigors, RUQ pain referred to shoulder and diarrhoea. Stool culture and microscopy shows cysts. What is the cause?

A

amoebiasis with liver abscess

133
Q

ID that can cause gross eosinophilia?

A

parasitic worm infections due to pulmonary eosinophilia

134
Q

complications of meningitis?

A

hearing loss
seizures and epilepsy
cognitive impairment
memory loss

135
Q

post gastroenteritis complications

A

Lactose intolerance
Irritable bowel syndrome
Reactive arthritis
Guillain–Barré syndrome

136
Q

GE management?

A

Stool MC&S
Assess dehydration- fluid challenge
Diaoralyte if necessary (rehydration)
Advise them to stay off work or school for 48 hours after symptoms have completely resolved
Antibiotics should only be given in patients that are at risk of complications and once the causative organism is confirmed.

137
Q

how long do newborns of HIV positive mothers need treatment for?

A

4 weeks

can only be delivered by vagina if undetectable load

3b specialties (7 decks)

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