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Medicine finals > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

How may cellulitis present?

A 
Erythema
Warm or hot to the touch 
Tense
Thickened
Oedematous
Bullae
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2
Q

What sign can be indicative of a S.aureus cellulitis?

A

Golden-yellow crust

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3
Q

What are the most common causes of cellulitis?

A

S.aureus
Group A Strept (S.pyogenes)
Group C Strept (S.dysgalactiae)

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4
Q

What classification can be used to assess the severity of cellulitis?

A

Eron Classification

Class 1 - no systemic toxicity or comorbidities

Class 2 - systemic toxicity or comorbidity

Class 3 - Significant systemic toxicity or significant comorbidity

Class 4 - Sepsis or life-threatening infection

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5
Q

When should a patient be admitted for IV antibiotics in cellulitis?

A

Class 3 or 4

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6
Q

What is the first line antibiotic for cellulitis?

A

Flucloxacillin

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7
Q

If a patient has a penicillin allergy, what antibiotic should be given if they have cellulitis?

A

Clarithromycin

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8
Q

What type of organism is Neisseria meningitidis?

A

Gram negative diploccocus

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9
Q

What type of meningitis is associated with a non-blanching rash?

A

Meningococcal septicaemia

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10
Q

What does the non-blanching rash in meningococcal septicaemia indicate?

A

DIC

Subcutaneous haemorrhage

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11
Q

In children and adults, what are the most common cause of bacterial meningitis?

A

Neisseria meningitidis

Streptococcus pneumoniae

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12
Q

In neonates, what is the most common cause of bacterial meningitis?

A

Group B Streptococcus

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13
Q

How can meningitis present?

A 
Fever
Neck stiffness
Photophobia
Vomiting
Headache 
Altered consciousness
Seizures
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14
Q

What are the two special tests that can be used to assess for meningism?

A

Kernig’s test

Brudzinski test

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15
Q

In the community, what antibiotic should be given prior to transfer to hospital?

A

Benzylpenicillin (IM/IV)

Under 1: 300mg
1-9 years: 600mg
>10 years: 1200mg

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16
Q

Once admitted to hospital, what two investigations should be performed, ideally before initiating antibiotics in a patient with suspected meningitis?

A

Blood cultures

Lumber puncture

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17
Q

If meningococcal disease is suspected, what specific blood test should be performed?

A

Meningococcal PCR

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18
Q

What antibiotic regimen should be commenced in neonates under 3 months if they have bacterial meningitis?

A

Cefotraxime

Amoxicillin

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19
Q

In people over 3 months old, what antibiotic should be commenced if they have bacterial meningitis?

A

Cefotriaxone

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20
Q

Along with antibiotics, what other medication should be started in patients with bacterial meningitis and why?

A

Dexamethasone (QDS for 4 days)

Reduce frequency and severity of hearing loss and neurological damage

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21
Q

What can be used as a prophylaxis treatment in close contacts of a patient with bacterial meningitis?

A

Single dose of ciprofloxacin

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22
Q

What are the most common causes of viral meningitis?

A

Herpes simplex virus
Enterovirus
Varicella zoster virus

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23
Q

What drug can be used to treat viral meningitis caused by herpes simplex virus?

A

Acyclovir

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24
Q

When sending a LP for suspected meningitis, what tests should be requested?

A 
Bacterial culture
Viral PCR
Cell count
Protein
Glucose

(Paired serum glucose sample)

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25
Q

What are the complications of meningitis?

A 
Hearing loss
Seizures and epilepsy 
Cognitive impairment and learning disability
Memory loss
Focal neurological deficits
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26
Q

What bacteria causes tuberculosis?

A

mycobacterium tuberculosis

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27
Q

What type of bacteria is mycobacterium tuberculosis?

A

Bacillus

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28
Q

What type of staining is used in the assessment of tuberculosis and how is it described?

A

Ziehl-Neeson Staining

Acid-fast bacillus

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29
Q

How does TB spread through the body?

A

Through the lymphatics and blood

30
Q

What is latent TB?

A

Immune system encapsulates sites of TB infection and stops the disease progression

31
Q

How is it described if latent TB becomes reactivated

A

Secondary TB

32
Q

How is it described if the immune system is unable to control the TB causing disseminating, severe disease?

A

Miliary TB

33
Q

Give some sites of extrapulmonary TB

A 
Lymph nodes - cold abscess
Pleura 
CNS and spine (Pott's disease) 
Pericardium
GI system
GU system
Bones and joints
Cutaneous TB
34
Q

Describe the BCG vaccine

A

Interdermal infection of live attenuated TB

35
Q

Prior to the BCG vaccine, what test needs to be performed?

A

Mantoux test (get the vaccine if it is negative)

36
Q

How can TB present?

A

Chronic, gradually worsening symptoms

Lethargy
Fever
Night sweats
Cough ± haemoptysis
Lymphadenopathy
Erythema nodosum
Spinal pain - in spinal TB (Potts disease)
37
Q

What are the two tests to assess for an immune response to TB?

A

Mantoux test

Interferon Gamma Release Assay

38
Q

What does the Mantoux test look for?

What does it indicate?

A

Previous immune response to TB

Previous vaccination
Latent TB
Active TB

39
Q

Describe how a Mantoux test is performed

A

Tuberculin is injected into the transdermal space
Causes a bleb to form
If >5mm after 72 hours = positive

Need to assess for active disease

40
Q

Describe how an Interferon-Gamma Release Assay is performed

A

Sample of blood is mixed with antigens from TB

Previous contract with TB = WBC sensitised to antigens –> release interferon-gamma

41
Q

What is the role of IGRA test in patients who have a positive Mantoux test with no active disease?

A

Latent TB

42
Q

What are the potential CXR appearances in primary TB

A

Patchy consolidation
Pleural effusions
Hilar lymphadenopathy

43
Q

What are the potential CXR appearances in reactivated TB?

A

Patchy/nodular consolidations with cavitation

44
Q

How might miliary TB look on CXR

A

Millet seeds

45
Q

What are the three ways to collect culture samples in the investigation of TB?

A
  1. Sputum
  2. Mycobacterium blood culture
  3. Lymph node aspiration or biopsy
46
Q

How can Latent TB be managed in an otherwise healthy patient?

A

No treatment

47
Q

How can Latent TB be managed in patients who are at risk of reactivation?

A

Isoniazid and rifampicin for 3 months

OR

Isoniazid for 6 months

48
Q

What drugs are used in the management of active TB?

A

Rifampicin - 6 months
Isoniazid - 6 months
Pyrazinamide - 2 months
Ethambutol - 2 months

49
Q

Alongside, Rifampicin, Isoniazid, Pyrazinamide and Ethambutol, what other drug should be prescribed and why?

A

Pyridoxine (prophylaxis against the peripheral neuropathy caused by isoniazid)

50
Q

What are some side effects of Rifampicin?

A

Red/orange secretions
Potent induce of cytochrome p450
Hepatotoxicity

51
Q

What is the side effects of Isoniazid?

A 
Peripheral neuropathy (co-prescribe pyridoxine)
Hepatotoxicity
52
Q

What is the side effect of pyrazinamide?

A

Hyperuraemic –> gout

Hepatotoxicity

53
Q

What is the side effect of ethambutol?

A

Reduced visual acuity

Colour blindness

54
Q

What type of virus is HIV?

A

RNA Retrovirus

55
Q

Give some examples of AIDS defining illnesses

A 
Kaposi's Sarcoma
PCP
Cytomegalovirus infection
Candiadiasis (bronchial, oesophageal)
Lymphomas
TB
56
Q

How long may an antibody test for HIV be negative after a potential exposure?

A

3 months

57
Q

How is HIV screened for in hospital?

A

Antibody blood test

58
Q

In HIV PCR testing, what antigen is tested for?

A

p24 antigen

59
Q

What type of testing gives the viral load of HIV?

A

HIV RNA PCR testing

60
Q

What is the normal range for CD4 cells?

A

500-1200 cells/mm3

61
Q

What CD4 count is considered as end stage HIV/AIDS?

A

<200 cells/mm3

62
Q

Define viral load in regards tro HIV

A

Number of copies of HIV RNA per ml of blood

63
Q

Who is offered ART?

A

Anyone with a diagnosis of HIV regardless of CD4 levels or viral load

64
Q

What is the aim of treatment in HIV?

A

Achieve a normal CD4 count and an undetectable viral load

65
Q

What is the recommended starting regimen in HIV treatment?

A 
2 NRTIs (nuclease reverse transcriptase inhibitors) - tenofovir, emtricitabine
1 other agent
66
Q

What are the classes of HIV ARTs?

A

Protease inhibitors
Integrase inhibitors
Nuclease reverse transcriptase inhibitors
Non-nucleoside reverse transcriptase inhibitors
Entry inhibitors

67
Q

What should be given as prophylaxis against PCP and at what CD4 count should this be initiated?

A

Co-trimoxazole

CD4 <200/mm3

68
Q

How often should a female patient with HIV attend cervical screening?

A

Every year

69
Q

What vaccinations should a person living with HIV have?

A 
annual influenza
pneumococcal (5-10y)
Hep A and B 
Tetanus
Diphtheria
Polio
70
Q

What type of vaccines should be avoided in people living with HIV?

A

Live

71
Q

How long should a newborn be given ART if they are born to a HIV positive mother?

A

4 weeks

72
Q

How long post-exposure can post-exposure prophylaxis to HIV be given?

A

Within 72 hours

combination ART for 28 days

Medicine finals (12 decks)

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