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Medicine > Infectious diseases > Flashcards

Infectious diseases Flashcards

1
Q

Amoebic dysentry

  • cause
  • features
  • diagnosis
  • treatment
A 
Entamoeba histolytica protozoan
Spread by faecal-oral route
Features: profuse bloody diarrhoea
May be a long incubation period
Diagnosis: Stool microscopy may show trophozoites if examined within 15mins or kept warm
Treat with metronidazole
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2
Q

Amoebic liver abscess

  • what is it
  • features
  • diagnosis
  • treatment
A

Single mass in the right lobe of liver
Contents of abscess often described as ‘anchovy sauce’
Feature: fever, RUQ pain
Diagnosis: serology is positive in >90% of cases
Treatment: metronidazole followed by a luminal amoebicide. Abscess may require image-guided drainage

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3
Q

Resp antibiotics

  • exacerbations of chronic bronchitis
  • uncomplicated CAP
  • atypical pneumonia
  • HAP
A
  • COPD exacerbation: amoxicillin, doxycycline or clarithromycin
  • CAP: amoxicilline
  • Atypical pneumonia: clarithromycin

-HAP: co-amoxiclav or cefuroxime if within 5 days of admission
Tazocin if more than 5 days after admission

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4
Q

Abx for:

  • lower UTI
  • pyelonephritis
A
  • lower UTI: trimethoprim or nitrofurantoin (or amoxicillin or cephalosporin)
  • Pyelonephritis: broad-spec cephalosporin (cefuroxime, ceftriaxone) or quinolone
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5
Q

Skin abx

  • impetigo
  • cellulitis
  • animal/human bite
  • mastitis
A
  • impetigo: topical fusidic acid or oral flucloxacillin
  • cellulitis: flucloxacillin (co-amoxiclav if near eyes or nose)
  • animal/human bite: co-amoxiclav (doxy+metro if pen allergic)
  • mastitis: flucloxacillin
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6
Q

ENT abx

  • throat infections
  • sinusitis
  • otitis media
  • otitis externa
A
  • throat: phenoxymethylpenicillin
  • sinusitis: amoxicillin (or doxy)
  • otitis media: amoxicillin (erythromycin if pen allergic)
  • otitis externa: flucloxacillin (or erythromycin if pen allergic)
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7
Q

Genital abx

  • gonorrhoea
  • chlamydia
  • PID
  • Syphillis
  • Trichomonas vaginalis
  • Bacterial vaginosis
A
  • Gonorrhoea: IM ceftriaxone
  • Chlamydia: azithromycin or doxycycline
  • PID: IM ceftriaxone + metronidazole PO + doxycycline PO
  • Syphilis: Benzathine benzylpenicillin IM
  • Trichomonas vaginalis: metronidazole PO
  • BV: Metronidazole PO
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8
Q

GI abx-

  • Clostridium difficile
  • Campylobacter enteritis
  • Salmonella
  • Shigellosis
A
  • Clostridium difficile: first episode metronidazole, if second/multiple episodes then vancomycin
  • Campylobacter enteritis: clarithromycin
  • Salmonella: ciprofloxacin
  • Shigellosis: ciprofloxacin
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9
Q

Abx protein synthesis inhibitors

  • examples
  • Adverse features of each example
A

Aminoglyclosides (gentamicin, vancomicin): nephrotoxicity, ototoxicity

Tetracyclines (doxycycline): skin discolouration, photosensitivity

Chloramphenicol: aplastic anaemia

Clindamycin: common cause of C diff

Macrolides (azithromycin, clarithromycin): nausea, P450 inhibitor, prolonged QT

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10
Q

BCG vaccine

  • what does it contain
  • how is it given
  • who is it given to
  • contraindications
A
  • Contains live attenuated Mycobacterium bovis
  • Given intradermally on lateral aspect of upper left arm. Tuberculin skin test must be done first
  • Given to: infants living in high risk UK areas, infants with high risk family members, children who have lived in a high risk country, healthcare workers, prison staff, those working with homeless people
  • CI: immunosuppression, previous BCG vaccine, a past hx of TB, pregnancy, positive tuberculin test
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11
Q

Cellulitis

  • Causative organism
  • Features
  • Eron Classification
  • IV abx criteria
  • Management
A

Inflamm of skin and subcut tissues, typically due to Strep pyogenes or Staph aureus

Features: commonly occurs on the shins, erythema, pain, swelling, may have systemic illness (fever)

Eron Classification:

  1. No systemic toxicity, no uncontrolled co-morbidities
  2. Systemically unwell, or co-morbidities
  3. Significantly systemically unwell or unstable co-morbidities
  4. Sepsis or a severe life-threatening infection
IV abx required for:
Eron classification 3 or 4
Severe or rapidly deteriorating cellulitis
Very young or frail
Immunocompromised
Significant lymphoedema
Facial cellulitis

Management: Flucloxacillin for mild/moderate
Co-amoxiclav or ceftriaxone for severe cellulitis

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12
Q

Cholera

  • cause
  • features
  • management
A

Cause: Vibro cholerae (gram neg bacteria)

Features: profuse ‘rice water’ diarrhoea, dehydration, hypoglycaemia

Management: oral rehydration therapy, antibiotics (doxycycline or ciprofloxacin)

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13
Q

Bacteria

  • gram positive cocci
  • gram negative cocci
  • gram positive rods/ bacilli
  • gram negative rods/ bacilli
A
  • gram pos cocci: Staphylococci, streptococci, enterococci
  • gram neg cocci: neisseria, moraxella
  • gram pos rod: clostridium, diphtheria, listeria
  • gram neg rod: E coli, Haem influenza, Pseudomonas aeruginosa, Salmonella, shigella, campylobacter
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14
Q

Cryptosporidiosis

  • what is it
  • who is at risk
  • features
  • diagnosis
  • management
A
  • Protozoa
  • More common in immunocompromised patients and young children
  • Features: watery diarrhoea, abdo cramps, fever
  • Diagnosis: modified Ziehl-Neelson stain (acid-fast) of the stool
  • Mx: supportive
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15
Q

Dengue fever

  • what is it
  • features
  • treatment
A
  • Viral infection, can progress to viral haemorrhagic fever, 7 day incubation period
  • Features: headache (retro-orbital), fever, myalgia, pleuritic pain, facial flushing, maculopapular rash
  • treatment: entirely symptomatic (fluids, blood transfusion, etc)
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16
Q

Diphtheria features

A

Recent travel to eastern europe/russia/asia
Sore throat with a diphtheric membrane (necrotic mucosal cells on tonsils)
Bulky cervical lymphadenopathy
Neuritis
Heart block

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17
Q

Enteric fever (typhoid/ paratyphoid)

  • what is it caused by
  • transmission
  • features
  • complications
A
  • Typhoid is caused by Salmonella typhi and paratyphoid is caused by Salmonella paratyphi
  • Transmitted via faecal-oral route
  • Features: systemic upset (headache, fever, arthralgia), relative bradycardia, abdo pain and distension, constipation, rose spots on the trunk
  • complications: osteomyelitis, GI bleed/ perforation, meningitis, cholecystitis
18
Q

Malignancies associated with Epstein-Barr virus

A

Burkitts lymphoma, Hodgkins lymphoma, nasopharyngeal carcinoma, HIV-associated CNS lymphomas

19
Q

E coli

  • what type of bacteria is it
  • what infections does it often cause
  • E coli O157:H7
A
  • Gram neg rod
  • UTI, diarrhoeal illnesses, neonatal meningitis
  • E coli O157:H7 causes a severe, haemorrhagic watery diarrhoea with a high mortality rate. Can be complicated by HUS
20
Q

Causes of gastroenteritis

A

Traveller’s diarrhoea: E coli most common. = At least 3 loose stools in 24hrs with or without abdo cramps, fever, nausea, vomiting, or blood in stool

E Coli: common amongst travellers, watery stools, abdo cramps, nausea

Giardia Lamblia: prolonged, non-bloody diarrhoea

Cholera: profuse watery diarrhoea, severe dehydration, not common amongst travellers

Shigella: bloody diarrhoea, vomiting, abdo pain

Staph aureus: severe vomiting, short incubation

Campylobacter: flu-like prodrome, may mimic appendicitis, may cause guillain-barre syndrome

21
Q

Features of HIV seroconversion

A 
Typically occurs 3-12 weeks after infection
Sore throat
Lymphadenopathy
Malaise, myalgia, arthralgia
Diarrhoea
Maculopapular rash
Mouth ulcers
Rarely meningoencephalitis
22
Q

Diagnosis of HIV

A

HIV PCR and p24 antigen tests can confirm diagnosis

HIV antibody test is most common and accurate test (ELISA and Western blot). Most patients develop HIV antibodies at 4-6 weeks.

p24 antigen test: usually positive from about 1 week to 3-4 weeks after infection

Testing HIV in an asymptomatic person should be done at 4 weeks after possible exposure, repeat test at 12 weeks if result is negative

23
Q

Treating HIV

A

Highly active anti-retroviral therapy (HAART) involves a combination of at least 3 drugs: two nucleoside reverse transcriptase inhibitors and either a protease inhibitors or a non-nucleoside reverse transcriptase inhibitor

Start HAART as soon as diagnosis is made

24
Q

Kaposi’s sarcoma

A

Occurs in HIV patients
Connective tissue cancer caused by Human Herpes Virus 8
Presents as purple papules or plaques on the skin or mucosa
Skin lesions may ulcerate
Resp involvement: massive haemoptysis and pleural effusion

Treat with radiotherapy and resection

25
Q

Neurocomplications of HIV

A 
Toxoplasmosis
Primary CNS lymphoma
TB
Ecephalitis
Cryptococcus
Progressive multifocal leukencephalopathy
AIDS dementia complex
26
Q

HIV opportunistic infections and disorders

A

CD4 200-500: Oral thrush, shingles, hairy leukoplakia, kaposi sarcoma

CD4 100-200: Pneumocystis jiroveci, HIV dementia, Cryptosporidiosis, cerebral toxoplasmosis

CD4 50-100: Aspergillosis, Oesophageal candidiasis, cryptococcal meningitis, primary CNS lymphoma

27
Q

Pneumocystis jiroveci (PCP)

  • what is it
  • prophylaxis
  • features
  • Ix
  • Mx
A 
Unicellular eukaryote (fungus)
All patients with CD4 count <200 should receive PCP prophylaxis

Features: dyspnoea, dry cough, fever, very few chest signs
Pneumothorax is a common complications
Extrapulmonary features: hepatosplenomegaly, lymphadenopathy, choroid lesions

Ix: CXR (bilateral interstitial pulm infiltrate), exercise-induced desaturation, bronchoalveolar lavage

Mx: Co-trimoxazole, steroids if hypoxic

28
Q

Gram positive vs gram negative staining

A

Gram positive will turn purple/blue

Gram negative will be red/pink

29
Q

Infectious mononucleosis

  • what is it
  • features
  • diagnosis
  • management
A

Glandular fever, caused by Epstein Barr virus

Features:
Classic triad of sore throat, pyrexia, lymphadenopathy

Other features: malaise, anorexia, headache, splenomegaly, hepatitis, lymphocytosis, haemolytic anaemia
Maculopapular pruritic rash develops if amoxicillin is given

Symptoms typically resolve after 2-4 weeks

Diagnosis: monospot test and FBC in the 2nd week of illness to confirm diagnosis

Management: rest, fluid, simple analgesia, avoid contact sport for 8 weeks due to risk of splenic rupture

30
Q

Lyme disease features

A

Spread by ticks

Bulls eye rash, fever, arthralgia, heart block, myocarditis, facial nerve palsy, meningitis

31
Q

Investigations and management of Lymes disease

A

Ix: clinical diagnosis if bulls eye rash is seen, otherwise ELISA antibodies to Borrelia Burgdorferi are first line test

Mx: doxycycline

32
Q

Features and complications of malaria

A

Features: schizonts on a blood film, parasitaemia, hypoglycaemia, acidosis, temp >39, severe anaemia

Plasmodium vivax/ovale causes a cyclical fever every 48 hours, Plasmodium malariae causes a cyclical fever every 72 hours

Complications: cerebral malaria (Seizure, coma), AKI, ARDS, hypoglycaemia, DIC

33
Q

Management of malaria

A

Plasmodium falciparum:
Uncomplicated: combination therapy is first line (eg. artesunate plus mefloquine, or aertesunate plus sulfadoxine-prtimethamine)

Severe: IV artesunate

Non-falciparum malaria:
Chloroquine or artesunate-based combination therapy like above

34
Q

Interpreting mantoux test (Tuberculin Skin Test)

A

Intradermal injection -> result read 48-72 hours later
Positive result: erythema and induration >10mm. Implies previous exposure including BCG (if strongly positive, ?TB)

False negative Mantoux test: immunosuppression, sarcoidosis, lymphoma, extremes of age, fever, hypoalbuminaemia, anaemia

35
Q

Necrotising fasciitis

  • what is it
  • two types
  • features
  • management
A

Medical emergency, difficult to recognise in early stages

Type 1: caused by mixed anaerobes and aerobes (often post-op in diabetics), most common type
Type 2: Strep pyogenes

Features: acute onset, painful erythematous lesion, often presents as rapidly worsening cellulitis with pain out of keeping with physical features, extremely tender over infected tissue

Management: urgent surgical debridement, IV abx

36
Q

Norovirus

  • features
  • transmission
  • limiting transmission
  • diagnosis
  • management
A
  • Features: symptoms develop within 15-50 hours of infection, N+V, diarrhoea, headache, low grade fever, myalgia
  • Transmission: faecal-oral
  • Limiting transmission: isolation, good hand hygiene with soap and water
  • Diagnosis: clinical history and stool culture viral PCR
  • Mx: self-limiting (72hrs), rehydration and electrolyte supplementation
37
Q

Post-exposure prophylaxis for HIV

A

Combination of oral antiretrovirals as soon as possible, ideally within 1-2 hours but may be started up to 72 hours following exposure, for 4 weeks

38
Q

Which vaccinations should be given to hyposplenic patients?

A 
Pneumococcal (every 5 years)
Haemophilus type B
Meningococcal type C
Annual influenza vaccine
Penicillin V prophylaxis (at least 2 years but often for life)
39
Q

Tetanus

  • organism
  • transmission
  • features
  • management
A
  • Clostridium tetani
  • Tetanus spores are present in soil and may be introduced into the body from a wound
  • prodrome fever, lethargy, headache, trismus (lockjaw), risus sardonicus, opisthotonus (arched back, hyperextended neck), spasms (eg. dysphagia)
  • Management: supportive (ventilatary support, muscle relaxants), IM human tetanus immunoglobulin for high risk wounds, metronidazole abx
40
Q

Indications for annual influenza vaccination

A 
65yrs+
Chronic resp disease
Chronic heart disease
Chronic kidney disease
Chronic liver disease
Chronic neuro disease
DM
Immunosuppression
Hyposplenism
Pregnancy

Health and social care staff
Those in long term residential homes
Carers

41
Q

Indications for pneumococcal vaccine

A 
65yrs+
Hyposplenism
Chronic resp disease
Chronic heart disease
CKD
Chronic liver disease
Immunosuppression
DM
Cochlear implants
Cerebrospinal fluid leaks
42
Q

Yellow fever

  • what is it
  • features
A

Viral haemorrhagic fever
Zoonotic infection
Incubation period 2-14 days

Features:

  • may cause mild flu-like illness lasting less than one week
  • Sudden onset high fever, rigors, N+V, bradycardia. Brief remission followed by jaundice, haematemesis, oliguria
  • Councilman bodies (inclusion bodies) may be seen in the hepatocytes

Medicine (15 decks)

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