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Phase 4 > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

By which means can HIV be transmitted?

A

Sexual fluids
Blood
Breast milk

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2
Q

How can HIV be prevented?

A

Condom use

Post exposure Prophylaxis:
- short term antiviral therapy given immediately after exposure. Given up to 72 hours.

Pre exposure prophylaxis:
use of antiretrovirals in high risk groups

Antiviral use in pregnancy to avoid vertical transmission

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3
Q

How does primary HIV infection usually present?

A

2-12 weeks following exposure.

  • flu like symptoms
  • erythematous/ maculopapular rash
  • lymphadenopathy
  • pharyngitis
  • Diarrhea
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4
Q

How is HIV tested for?

A

ELSIA for p24 antigen

ELSIA for HIV antibody
**both these are diagnostic

Rapid point of care testing: swap from mouth or finger prick
- require serological confirmation

Viral load

PCR of viral load

CD4 count
- this is not diagnostic but is used as marker to establish how the immune system is coping.
<200 is AID defining

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5
Q

If an asymptomatic patient has a negative result for HIV, what should be done next?

A

A repeat of test 12 weeks later

- by 3 months a 99% of people with HIV will have created antibodies towards the virus

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6
Q

What are some of the common opportunistic infections in HIV?

A

Pneumocystis Jirovecii

  • progressive SOB
  • Dry cough
  • co-trimoxazole

Candidiasis

  • odynophagia
  • dysphagia
  • fluconazole

Cryptococcus Neoformans

  • meningitis
  • molluscum papules
  • lung disease
  • Amphotericin

Toxoplasma Gondii
- intracranial mass

CMV

  • retinitis
  • encephalitis
  • G.I disease

Cryptosporidium

  • watery diarrhoea
  • Pancreatitis
  • Cholangitis
  • supportive

Kaposi Sarcoma:

  • HHV-8
  • chemotherapy

Lymphoma
- Burkitt’s’

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7
Q

In which disease should an HIV test also be done?

A

TB
Hep B and C
Lymphoma - namely NHL

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8
Q

What are some differentials for HIV?

A

infectious mononucleosis
- EBV

Secondary syphilis

Viral infections

Drug allergy

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9
Q

Which sexually transmitted infections do not cause discharge but only a lesson, and divide these into painful and painless lesions:

A

Painless

  • treponema pallidum - chancre lesions
  • Condyloma accumulata (HPV virus)
  • Granulomatosis inguinal (Klebsiella)

Painful:

  • herpes
  • lymphogranulomatous venereum
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10
Q

What are the stages of treponema pallidum:

A

Primary Syphilis:

  • painless chancre
  • high infectious

Secondary dissemination

  • maculopapular rash - palms and central body
  • condyloma lata (raised pale plaques)
  • fever
  • headache

Tertiary:

  • neurosyphilis
  • aortitis
  • Argyll robertson pupil
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11
Q

What are the swollen lymph nodes in lymphogranulomatous venereum called?

A

Bubo’s nodes

- swollen abscess nodes that can burst

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12
Q

How is bacterial vaginosis diagnosed and what is the bacteria?

A

Gardnerella Vaginosis

Gram staining:
- clue cells

pH >4.5

Treatment:
metronidazole

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13
Q

What types of antiretroviral treatment is available for HIV? and when should it be started?

A

CCR5 antagonist

Nucleotide reverse transcript inhibitors

Non - Nucleotide reverse transcript inhibitors

Protease inhibitors

Integrase inhibitors

**everyone HIV positive should be started on HAART regardless of CD4 count.

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14
Q

What does a septic screen all include?

A 
FBC 
Inflammatory markers - ESR, CRP 
Urine cultures 
Sputum 
Blood cultures 
Microbiological swaps 
CXR
  • stop all biotics if possible before doing so
  • echo if new murmur
  • check sickle cell status
  • LP if CNS symptoms
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15
Q

Which extremely infectious disease is characterised by greyish white spots on the buccal mucosa? and what are these lesions called?

A

Measles

Koplik spots

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16
Q

What are some complications of measles?

A

Otitis media

Pneumonia

Acute Demyelinating Encephalitis

Conjunctivitis

> 10 years later:
- Subactue sclerosing panencepahalitis

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17
Q

Scarlet fever, name some of the characteristic findings, complications and how is it treated?

A

Scarlet fever
- caused by strep pyogenes (group A)

Symptoms:

  • pharyngitis
  • Maculopapular rash starting on the neck and spreading across body predominantly affecting flexures (spares palms and soles)
  • White coat with large papilla seen on tongue (strawberry tongue)

Complications include:

  • glomerulonephritis - Post strep
  • Peritonsillar abscess
  • Rheumatic fever
  • Otitis media (and its complications)

Treatment:

Penicillin V

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18
Q

What high contagious infection which presents with erythematous macular rash and lymphadenopathy can be dangerous to pregnant women? what are the complications in pregnancy?

A

Rubella

Highly dangerous during the 1st trimester

Congenital rubella syndrome:

  • neurosensory deafness
  • cataract formation
  • congenital heart disease - patent ductus arterioles
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19
Q

What is the classification system used for cellulitis and when should surgery be indicated?

A

Enron classification

1 - no signs of systemic toxicity and controlled comorbidities

2 - systemically unwell or as comorbidities which may complicate

3 - Shock or comorbidities which are interfering with treatment

4 - Septic or Nec Fas

*Eron Classification 4 = surgery

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20
Q

What investigations should be done into cellulitis?

A

Bloods:

  • FBC
  • CRP
  • Blood cultures (if pyrexial)
  • D-dimer? - not so useful in acute infections often

Skin swabs
- MRSA

Ultrasound
- exclude DVT

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21
Q

What is the broad management of Necrotising fasciitis?

A

IV antibiotics

Urgent surgical review

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22
Q

What is the antibiotic management for cellulitis?

A

Enron <2
Oral:
- Flucloxacillin
or if penicillin allergic: Doxycycline

Enron >2
- IV Flucloxacillin
or
- Vancomycin

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23
Q

What must be present for a diagnosis of acne vulgaris to be made?

A 
Comedones
Papules 
Pustules 
\+ 
Erythema

Severe:
Nodules
Cysts

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24
Q

Which pneumonia presents with flu like symptoms and a dry cough, and on bloods may demonstrate hyponatremia?

A

Legionella

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25
Q

If a pregnant woman has positive urine cultures but is asymptomatic what is the management?

A

Antibiotic therapy
- always treat a pregnant female. it can quickly progress to pyelonephritis

Nitrofurantoin is the antibiotic of choice.

If a pregnant woman had pyelonephritis it would be co-amoxiclav

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26
Q

If a pregnant woman comes into contact with some with erythema infectiosum what should be done, what is this disease also known as and what are the typical appearances?

A

Also known as fifths disease, or slapped cheek syndrome.

Pregnant woman:
Immediate IgM and IgG antibodies in the mother.

USS of foetus

  • fetus hydrops
  • increased risk of spontaneous miscarriage

Signs of a child with erythema infectiosum:

  • fever
  • bright red cheeks
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27
Q

What are the anti-malaria regimes that can be given?

A

Atovaquone + Malarone = 7 days before

Chloroquine = 4 weeks before

Doxycycline = 4 weeks before

Mefloquine = 4 weeks before

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28
Q

Name some hospital acquired pneumonia causing bacteria:

A

E. Coli

Klebsiella pneumonia

Acinetobacter species

Staph aureus

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29
Q

When is staph aureus most likely to cause pneumonia?

A

Following Influenzas infection

ICU patients

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30
Q

How does Pneumocystis jiroveci present?

A

Dry cough

High fever

Breathlessness

Big drop in saturations during exercise

*with a clear chest

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31
Q

What organisms can cause TB?

A

Mycobacterium tuberculosis

Mycobacterium Bovis

Mycobacterium Africanum

Mycobacterium microti

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32
Q

What skin manifestations can be seen with TB?

A

Lupus Vulgaris

Erythema nodosum

Scrofuloderma

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33
Q

A patient receives treatment for syphilis, and shortly after develops a fever, rash and becomes tachy. there is no wheeze or sign of airway disruption. what has happened?

A

Jarisch-Herxheimer reaction

- release of endotoxins

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34
Q

What is the new guidelines with regards to gonorrhea treatment?

A

IM ceftriaxone

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35
Q

Which infectious diseases can cause low platelets?

A

malaria

Dengue fever

HIV

Typhoid

Severe sepsis

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36
Q

Which patients are at risk of developing staph aureus bacteremia?

A

IVDUs

Indwelling IV lines
- cannulas

Patient’s with complicated skin disorders

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37
Q

What is the definition of septic shock?

A

Sepsis induced hypotension requiring Inotropic support that is unresponsive to adequate fluid resuscitation within 1 hour.
Systolic <90mmHg
or
Reduction of >40mmHg from baseline

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38
Q

How quickly should neutropenic patients be assessed once presenting?

A

Within 15 mins

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39
Q

What antibiotics should be given for ascending cholangitis?

A 
Amoxicillin 
\+ 
Gentamicin 
\+ 
Metronidazole
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40
Q

What extrapulmonary symptoms may be present in TB?

A

Systemic features

Gastro-intestinal:

  • coliky pain
  • Adhesions/ bowel obstructions

Lymphadenopathy:

  • painless cervical enlargement
  • sinus formation

CNS TB:
- focal neurological signs

Skin:
- Lupus vulgaris - apple jelly nodules

Miliary TB:
Millet formation throughout the lung

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41
Q

What are the risk factors for TB?

A

Being around someone with TB

HIV infection

TNF alpha inhibitors

Overcrowding
- prisons

Homeless

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42
Q

What are the two tests that can be done to diagnose latent TB?

A

Mantoux test

Interferon Gamma Release Assays
- used to confirm

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43
Q

What drug should be prescribed alongside the treatment for TB?

A

Pyridoxine
- vitamin B6

this is to help protect against the adverse effects of isoniazid

44
Q

How is pneumocystis jirveco treated?

A

Co-trimoxazole

45
Q

How is MRSA Eradicated from skin or mucosal membranes?

A

Nasal Mupirocin

Chlorhexidine gluconate 4% scrub

46
Q

How should a patient with Staph Bacteremia be treated?

A

Flucloxacillin
or
Vancomycin

Investigate:

  • echo
  • possible sources of infection

replace intravascular devices

Contact microbiology

Complete Staph Aureus Bacteremia sticker

47
Q

What is the characteristic rash of measles? How is measles treated?

A

Maculopapular rash that begins on the head> neck> trunk

Treatment:

  • supportive
  • vitamin A

Immunocompromised:
- immunoglobulins

Vaccine- MMR

48
Q

What is a clinical finding of mumps?

A

Tender swelling of glands

- namely parotid

49
Q

What are some complications of Mumps?

A

Pancreatitis

Meningoencephalitis

Epididymo-orchitis

50
Q

What type of rash appears following a tick bite?

A

Erythema Migrans

51
Q

How is Mononucleosis tested for?

A

Monospot test
- can be false positives in pregnancy and haematological disease

Reverse transcriptase PCR

Blood film
- atypical lymphocytes

52
Q

How do tapeworms present, how are the diagnosed and how are they treated?

A

Mild G.I symptoms. (usually well adapted to not cause symptoms)
Tape worm segments in stool

Investigations:
- eggs/ segments in faeces

Treatment:
- anthelmintic agents - Niclosamide

53
Q

What are the symptoms, diagnostic tests, treatment of toxoplasmosis?

A

Toxoplasma Gondii
- 1/3rd of population infected

Symptoms:
*usually asymptomatic in immunocompetent

  • bilateral lymphadenopathy
  • fever
  • hepatosplenomegaly

complication:
- encephalitis
- retinitis
- hepatitis

Investigations:

  • serology
  • PCR

Treatment:

  • pyrimethamine + sulfadiazine + folinic acid
  • steroids if eye disease

Prophylaxis: co-trimoxazole

54
Q

List some causes of viral haemorrhagic fevers:

A

Ebola (Filovirus)

Crimean Congo fever (Bunyavirus)

Rift Valley fever (Bunyavirus)

Dengue fever (flavivirus)

Yellow fever (flavivirus)

55
Q

What is the management of cholera?

A

Diagnostics:
- rapid dipstick testing

Management:

  • Oral rehydration salts
  • IV fluids - if severely dehydrated
  • Zinc for children - reduces course of disease

Antibiotics if absolutely needed - doxycycline or azithromycin in pregnant

56
Q

If a patient has genital herpes and is pregnant how should they be managed?

A

Aciclovir and C -section if primary infection occurs >28 weeks

If secondary infection then Aciclovir throughout pregnancy

57
Q

What vaccine should be offered to Hepatitis patients?

A

Pneumococcal vaccine

58
Q

When should you suspect Ebola and how should the patient be managed?

A

Fever and recent visit to epidemic area.

Isolated.

59
Q

What pathogen is most associated with gangrene?

A

Clostridium Perfringens

*causes gas gangrene

60
Q

What disease does Parovirus B19 cause?

A

Erythema Infectiosum

61
Q

Which type of pneumonia is associated with reactivation of cold sores?

A

Strep Pneumonia

62
Q

What are some of the complications of Hep C?

A

Rheumatological problems
Cirrhosis
Hepatocellular cancer
membranous proliferative glomerulonephritis

63
Q

What is the management of Hep C?

A

Direct acting antivirals
- protease inhibitors combination - triple therapy

Sustained viralogical response - in which HCV is undetecacble after 6 months

64
Q

How is Hep C diagnosed?

A

HCV PCR

HCV Serology
- autoantibodies

65
Q

What is the most appropriate antibiotic for campylobacter?

A

Clarithromycin

66
Q

What cancers is EBV associated with?

A

Burkitt’s Lymphoma
Hodgkin’s lymphoma
Nasopharyngeal

67
Q

What is the single best step to reducing spread of MRSA?

A

Hand hygiene

68
Q

What are the parameters of qSOFA?

A

Reduced GCS
Breathes >22
Blood pressure <100

69
Q

How is chlamydia and gonorrhea tested for?

A

Males:
- first pass urine
+/- anal and throat swabs

Females:

  • Vulvovaginal swabs
  • Endocervical swabs

NAAT test

70
Q

What examinations should be done into suspected STI?

A

Visual inspection of the genitals - retract foreskin

scrotal tenderness/ scrotal enlargement

Speculum of cervix

Bimanual examination of uterus
- for pain/ enlargements/ adhesions

71
Q

What common investigations do you want to consider in a traveler returning with a fever?

A

Malaria thick and thin blood films
or
Rapid diagnostic testing

HIV test

FBC

  • Lymphopenia - viral infection?
  • eosinophilia - parasitic infection

LFTs
- hepatitis?

Blood cultures x 2

72
Q

In malaria, how many samples do you send and over how many days and why is this?

A

3 samples sent over 3 consecutive days. This is due to the life cycle of malaria being released every 48 hours.

73
Q

What are the complications of malaria?

A

Severe haemolytic anaemia
- urinalysis will show haemoglobinuria and haemasideruria

Cerebral malaria
- seizures

DIC

Seizures

AKI

Pulmonary oedema

74
Q

Which drugs can be given prophylactically for malaria?

A

Non- drug resistant:
- chloroquine

  • lots places are chloroquine resistant
  • not suitable for epileptic suffers

Drug resistant:

  • mefloquine
  • doxycycline

*mefloquine contraindicated in psychosis

75
Q

What are the symptoms of malaria P.Falciparum and what would you expect to see on blood results?

A 
Headache 
malaise 
Nausea, vomiting 
Diarrhea
Fever

Jaundice - haemolysis
Hepatosplenomegaly

Bloods:

  • thrombocytopenia
  • Low haemoglobin
76
Q

What operation may increase the risk of malaria?

A

Splenectomy

77
Q

What do the thick and thin blood films in malaria need to be stained with?

A

Giemsa staining

78
Q

What other test out with thick and thin blood smears may done to diagnose malaria?

A

Plasmodium LDH can be detected

79
Q

What is the treatment of P. Falciparum?

A

Artesunate - for severe (>2% parasitaemia)
or
Artemisinin Based Combination Therapy

IV fluids
Correction of electrolytes
Acid Base management
Correction of complications

80
Q

What is the management for Non Falciparum infections?

A

Oral chloroquine

Doxycycline

81
Q

What clinical features may be seen in HIV?

A

Skin:

  • maculopapular rash
  • Kaposi’s sarcoma
  • Molluscum contagiosum

Oropharynx:

  • gingivitis
  • oral thrush
  • oral hairy leukoplekia

Neck:
- lymphadenopathy

Eyes
- HIV retinopathy

CNS:

  • Progressive multifocal leukoencephalopathy
  • Toxoplasmosis - localising signs

Chest

  • Pleural effusion
  • TB

Abdomen
- Hepatosplenomegaly

Renal:
- HIV associated Renal disease

Anogenital:

  • Anal cancer
  • HSV
82
Q

What additional test should be done when investigating someone for HIV?

A 
Hepatitis serology 
STI screen - include syphilis 
Mantoux test for TB 
FBC 
LFTs
U&amp;Es
83
Q

What is the natural history of HIV?

A

Primary infection *high viral load, low CD4

  • 2 weeks following exposure.
  • Fever
  • maculopapular rash
  • Lymphadenopathy
  • Bell’s palsy
  • D&V
  • Oral genital ulceration *

Chronic/ Asymptomatic phase: *viral reduces, CD4 increases slightly
- average 9-12 years

Minor HIV associated disorders: Viral load increases, CD4 starts to drop

  • Oral candidiasis
  • Hairy leukoplakia
  • Recurrent infections
  • TB** - biggest killer
  • kaposi’s tumour
AIDS syndrome: high viral load, CD4 <200 
Aids defining illnesses 
- PJP 
- HIV wasting syndrome 
- Cerebral toxoplasmosis 
- Chronic herpes oral ulcers 
- Primary cerebral lymphoma
84
Q

What common mucocutaneous diseases occur in HIV?

A 
Mollucusum Contagiosum 
Secondary syphilis 
Kaposi's 
Psoriasis - becomes worse 
HSV infection 
Seborrhoeic dermatitis
85
Q

What is the underlying cause of Kaposi sarcoma?

A

HHS - 8

86
Q

How does progressive multifocal leukoencephalopathy present?

A

Stroke like episodes
Cognitive impairment

*caused by the JC virus

87
Q

In cognitive impairment in AIDS what should you think?

A

HIV associated neurocognitive disorders (dementia)
Depression
Neurosyphilis

88
Q

What is the most common cause of meningitis in AIDS?

A

Cryptococcus Neoformans

Amphotericin B is treatment

89
Q

What would you expect to see on the blood work of an HIV patient?

A

Pancytopenia, normocytic normochromic anaemia

- HIV and the cytokines induces impaired haematopoiesis

90
Q

What are the aims of ART in HIV?

A

To reduce the viral load to an undetectable level, reduce clinical progression and reduce mortality
Reduce HIV transmission

91
Q

In low income countries where choice isn’t available what does the WHO recommend as a starting point for ART therapy in HIV?

A

2 Nucleotide reverse transcriptase inhibitors (backbone)
+
1 Non - Nucleotide reverse transcriptase inhibitor

92
Q

What are some of the side effects of ART therpay?

A

Immune reconstitution inflammatory syndrome

  • immediate. steroids treat
  • a reaction that occurs as the immune system recovers and detects all these underlying infections

Lipodystrophy
- abnormal fat distribution

Rashes

Insomnia

Neuropsychiatric

93
Q

What is the classical symptoms seen in HSV-1 initial infection?

A

Fever
Sore throat
Oropharyngeal vesicles

These are the symptoms of Gingivostomatitis

94
Q

What are some of the complications of Herpes simplex virus?

A

Eczema herpticum

Herpes keratitis
- corneal scarring and vision loss

Meningitis

Bell’s Palsy

Immunocompromised host:

  • Encephalopathy
  • hepatitis
  • Retinitis
95
Q

When would HSV-1 require diagnostic testing?

A 
In signs of complications:
tests include: 
- PCR from swab 
- Serology markers 
- Immunofluorescence
96
Q

What are some differentials to HSV-1 and 2?

A

HSV-1
Contact dermatitis
Crohn’s disease - Oral lesions

HSV-2:

  • Chancroid
  • Syphilis
  • Lymphogranuloma Venereum
97
Q

What are the complications of Shingles?

A

Postherpetic neuralgia

  • Gabapentin
  • amitriptyline

Herpes zoster Opthalmicus
- V1 branch affected

Ramsay Hunt syndrome

Encephalitis

Bladder dysfunction
- if sacral nerves affected

98
Q

How is CMV treated?

A

Ganciclovir

99
Q

What are some of the complications of flu?

A

Otitis media

Pneumonia

  • Secondary bacterial Staph infection
  • viral pneumonia

Febrile convulsions

Encephalitis

Reye Syndrome

  • Encephalopathy + Fatty degenerative liver disease
  • typically affects children recovering from the flu
100
Q

What is the treatment for influenza and who gets it?

A

Oseltamivir - oral
Zanamivir - nasal inhaled

Chronic disease 
Immunosuppressed 
Pregnant 
<6 months 
BMI >40

*drugs should be given 48 hours after symptom onset.

101
Q

What vaccines are given for flu and who gets them?

A

Live attenuated
- 2- 17 years old

quadrivalent inactivated
- 17 - 64 years old

Trivalent inactivated
>65 year old

102
Q

What causes epiglottitis, how should it be managed and why is it rarely seen?

A

H.Influenza infection

Ceftriaxone
+
Clindamycin

Vaccine
- Hib Vaccine

103
Q

How does bronchiolitis present, what are the investigations and what is the treatment?

A

Respiratory syncytial virus

Coryza symptoms 
Low grade fever 
Wheeze 
Inspiratory crackles
Apnoea 
Poor feeding

Diagnostic:
- Nasopharyngeal aspirate

other things to consider:

  • ABG/ VBG
  • FBC
  • CRP
Management: 
- supportive 
- Supportive feed (NG tube) 
- supplement oxygen
\+/- 
- nebulized adrenaline (controversial)

Ribavirin - can be used for congenital heart disease/ lung disease patients.

104
Q

What is the treatment of chlamydia and treatment of N. Gonorrhoeae?

A

Chlamydia - Doxycycline

N. Gonorrhoeae: - Ceftriaxone

105
Q

What are some poor prognostic factors for malaria?

A

Increased age

Elevated serum lactate

Elevated schizonts in the blood

Phase 4 (49 decks)

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