Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Finals > Infectious diseases and micro > Flashcards

Infectious diseases and micro Flashcards

1
Q

Bacterial causes of pneumonia

A
  • Strep pneumonia
  • H. influenza
  • Staph aureus

Atypicals:

  • Legionella (stagnant warm water)
  • Mycoplasma pneumoniae
  • Chlamydia pneumonia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

fungal causes of penumpnia

A
  • histoplasmosis
  • cryptococcus
  • pneumocystis jiroveci (pneumocystis pneumnoia)
  • aspergillosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

viral causes of pneumonia

A
  • influenza
  • SARS
  • RSV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

signs of pneumonia O/E

A
  • dull percussion
  • increased tactile vocal fremitus
  • bronchial breath sounds
  • late inspiratory crackles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is the CURB65

A

pneumonia mortality risk

  • Confusion (abbreviated mental test <=8 or new
  • Urea >7mmol/L
  • Raised RR >=30
  • BP <90 S or <60 D
  • Age >=65

1 point- OP tx
2 points- IP tx or OP with close f/u
>3 points- IP tx with ITU admission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

ix pneumonia

A 
- CRP
!!!!- procalcitonin
- sputum culture/lavage
- bloods culture
- CXR- veil like opacity, +-lobar
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Tx peumonia

A

CAP

  • low severity- PO amoxicillin, doxy, clarithro, erythro
  • severe- PO or IV- coamox with clarithro if atypical or PO erythro

HAP

  • coamox PO or doxy, cefalexin
  • severe- IV Taz
  • add vanc/teic/linezolid if ?MRSA
  • pain meds
  • CPAP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what organism causes epiglottitis

A
  • Haemophilus influenza B
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

tx epiglottitis

A
  • keep child calm, do not lie them down
  • intubate under GA, THEN take bloods, cultures
  • rigid laryngoscopy
  • IV cefotaxime, chloramphenicol if allergy hx
  • rifampicin to household
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what organism tends to cause respiratory infections in CF patients

A
  • peusdomonas aeruginosa (adults)
  • S aureus (most common in children)
  • HiB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what organisms most commonly cause flu

A
  • influenza A, B, C
  • A and B= seasonal flu
  • A- pandemics
  • C- mild illness, no vaccine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

drug tx flu

A

antiviral eg oseltamivir PO or canamivir inhaled if any of the following apply:

  • -> national surveillance indicated flu is circulating
  • -> person is in ‘at risk’ group
  • -> person can start tx within 48hours of sx onset (off-label use outside of this duration, use clinical judgement)
  • -> person is not in at risk group but felt they may develop complications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is considered an ‘at risk’ group of flu

A
  • splenic dysfunction
  • sickle cell
  • coeliac
  • chronic resp disease
  • chronic heart, liver or kidney disease
  • neuro disease
  • diabetes
  • immunosupression (HIV, CT)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

advice to give someone with flu

A
  • oral fluids
  • paracetemol, NSAID
  • bed rest
  • fever, GI sx should start to resolve within 1w
  • fatigue, cough may last longer (2w)
  • safety net for hospital- confusion, no urine, persistent D+V, SOB, pleuritic chest pain, cough up blood
  • arrange f/u if no improvement in 1w
  • lower threshold for admission/visit to hosp if child/baby
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

causes of UTI/pyelonephritis

A 
- E.coli (most)
!!!- staph saprophyticus (young women)
- proteus
- Kelbsiella
- enterococcus faecalis
!!- yeast
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what organisms cause UTI with catheter

A
  • E.coli
  • candida
  • pseudomonas
  • enterococcus
  • staph aureus
  • coag -ve staph (S.epidermis, S capitis, S.haemolyticus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

causes of UTIs in children

A
  • E.coli
  • proteus (more common in boys)
  • pseudomonas (indicates structural abnormality
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

abx to tx UTIs

A
  • non pregnant women, men, children
    1. nitrofurantoin, trimethoprim
    2. amox, or if a man, consider prostatis/pyelonephritis if no improvement witin 48hours of 1st line
  • pregnant women
    1. nitro
    2. amox, cefalexin
  • asx- amox, cefalexin, nitro
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

tx recurrent UTIs

A

one dose after trigger/post coital, or once nightly

  1. nitro, or trimeth
  2. amox or cefalexin
    - review every 6months
    - suggest vaginal oestrogen in post meno women
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

tx UTIs with catheter

A

nitro/trimeth
if with upper UTI- cefalexin
IV- ceftriaxone, amikacin

Pregnant
1- cefalexin
IV cefuroxime

Children
1. cefalexin
IV- ceftriaxone, amikacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

tx pyelonephritis

A

Adults and children:
PO- cefalexin
IV- amikacin, ceftriaxone

pregnant-
cefalexine PO,
IV cefuroxime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

sx acute prostatitis

A
  • UTI- LUTS
  • weak stream
  • acute retention
  • lower back pain
  • perineal, penile or rectal pain
  • pain on ejaculation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

sx chronic prostatitis

A
  • complication of acute
  • at least 3m of urogenital pain
  • with LUTS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

ix ?prostatitis

A
  • MSU (shows UTI)
  • blood cultutres, FBC
  • abdo examination- distended bladder, costovertebral angle tenderness
  • DRE- GENTLY– do not massage or collect secretions for culture as you risk causing sepsis. Will feel warm, large and boggy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
management of prostatits
ABX - PO cipro, levofloxacin - IV amikacin, ceftriaxone PAIN - paracetemol +- low ose weak opioid, NSAID ADVICE - fluids - usual course= several weeks - safety net- worsening sx, sx dont improve within 48hour of starting abx, very feverish, confusion ADMIT - admit if severe, sepsis/retention/abscess sx, no improvement within 48hours of abx - urgent referral if immunocomprimised, pre-existing urological conditions eg BPH, indwelling catheter, STI is identified F/U - arrange f/u in 48hours to check on progress, review abx with culture results - reveiw abx after 14d- to continue? - refer to r/o structural abnormalities of the UT
26
management of sepsis
BUFALO 6 Inform seniors/get help - ask someone to catheterise - O2 - IV access- chultures, X match, clotting, FBC, UE, LFT, VBG - fluids- 500ml bolus NaCl 0.9% - IV abx - UO- make sure it's completed
27
abx used in sepsis
depends to local protocols, but generally: ADULTS Community acquired: - Tazocin (allergy-cefuroxime) - add vanc or teic or 2-linezolid if ?MRSA - anaerobic- add metro to broad spec cephalo eg cefuroxime - if resisatnt- meropenem ``` CHILDREN( 1m-18yrs)- comm acquired - aminoglycoside (gent, amikacin, streptomycin) plus amox/ampicillin - or cefotaxime/ceftriaxone alone ``` ALL PEEPS: Hospital acquired - IV taz or meropenem - add vanc or teic or 2. linezolid if ?MRSA- anaerobic- add metro to broad spec cephalo eg cefuroxime
28
tx sepsis ?related to vasc catheter
vanc or teic
29
tx meningococcal sepsis
- benzylpen or cefotaxime for 7d - chloramphenicol in pen allergy Meningitis: 3m-50years - cefotaxime or chloramphenicol or ceftriaxone 2-4g IV - note- dont give ceftriaxone in <3m as may lead to hyperbilirubinaemia and risks Kernicterus - add amox IV if >50y/<3m to cover for listeria - dexamethasone - IV aciclovir if ?viral Contacts: - ciprofloxacin, (rifampicin or ceftriaxone)
30
what counts as low urine output
1ml/kg/hour is normal <0.5ml/kg/hour is low anuria is <100mls in 24hours
31
Management of pt with low UO
A-E - high flow O2 - bloods- FBC, UE, clotting, gas - BP - fluid challende- 250-500ml boluses - aim for S >100mmHg - anuric- consider obstruction (post-renal)-- check catheter, bladder washout using 50mls normal saline - check drug chart- no renal damaging drugs (ACEI, NSAIDs, abx) - AKI--> furosemide
32
definition and sx of AKI
- oliguria <0.5mls/kg/hour for >6 hours or anuria - rise in Cr >26micromol/L in 48hours/50% rise in 7 days - JVP raised - chest auscultation- basal crackles - ankle oedema
33
what organism causes meningococcal sepsis, histological appearance
- Neisseria meningitidis - gram negative (pink) - diplocccus - intracellular - coffee bean shaped
34
histological appearance of strep pneumonia
- lancet shaped - (diplo)cocci - gram positive (purple)
35
histological appearance of E.coli
- rod shaped/bacilli - anaerobe - gram negative (pink)
36
what is trichomonas vaginalis
- spread through sexual contact - protozoan , single cells - flagella
37
sx trichomonas vaginalis
- 50% no sx - frothy, yellow/green discharge - fishy odour - itching - dysuria - dyspareunia - balanitis
38
signs trichomonas vaginalis
- strawberry cervic (colpitis macularis | - vaginal Ph raised (>4.5)
39
ix ?trich
- F- charcoal swab with microscopy (posterior fornix or self taken) - M- urethral swab or first catch urine
40
tx trich
- GUM referral | - metronidazole
41
what is a tapeworm, where is it caught from
- cestoda class worm - long worm - raw/undercooked meat, contaminated water
42
life cycle of a tape worm
- eggs passed in faces from host - ingested by intermediate host - hatch - larvae enter tissues of internmediate host - encyst - cysts ingested by human host
43
sx tapeworm
- mostly no sx - passage of worm (proglottids) !!!!- itching - vague GI sx- abdo pain, cramps, D+N, wt loss, malaise !!!!!- worm absorbs lots of B12- pernicious anaemia (paraesthesia, balance, confusion - hydatid cyst- liver, lungs
44
sx hydatid cyst in liver
- epigastric pain - dyspepsia - obstructive jaundice, pruritis (obstructs bile duct)
45
tx tapeworm
- praziquantel - niclosamide - neuro sx- albendazole - cyst aspiration - surgery
46
what is pinworm
- small slender worms with pointed tail - reside in caecum, appendix, ascending colon - enterobius vermicularia - primarily paediatric - transmitted via contact- bedblothes, bedding, towels, toilets, doorknobs, sex
47
sx pinworm
- asx - intense itching, prickling pain in anal area/vaginal - worse at night - abdo discomfort, loss of appetite rarely
48
ix pinworm
- glass slide microscopy by dabbing stretched anal folds with cellophane tape in the early morning :)
49
tx pinworm
- mebendazole, albendazole- 2 doses 2w apart - tx household and class at same time - wash sheets, clothing - strict handwashing and cleaning after appt
50
what is schistosomiasis (bilharzia)
- parasitic worm | - contact with fresh water and snails--> transmission
51
sx schistosomiasis
Acute: - maculopapular lesions - itchy - diarrhoea, cough - abdo pain - malaise, arthralgia Chronic: - bowel wall egg deposition- blood diarrhoea, cramping, perf, appednicitis - portal tracts- splenomegaly, ascites - UT- haematuria, dysuria, sq cell carcinoma - CNS sx - postcoital bleeding, ulceration, irreg menstruation
52
ix ?schistosomiasis
- microscopic examination for ova in stool/urine samples | - antiodies/antigens in blood or urine
53
tx schistosomiasis
- corticosteroids | - praziquantel
54
what is legionnaries disease
severe form of penumonia caused by legionella pneumophila - found in warm stagnant water and fresh water - cannot spread person to person
55
sx legionnaires disease
cough is dry pneumonia sx plus systemic infective sx: ``` headaches, muscle pain, chills fever fatigue cough, dyspnoea, chest pain N+V, diarrhoea chest pain ```
56
tx legionnaries disease
- notifiable disease - fluroquinolones- levofloxacine, cipro - macrolides- azithromycin, clarithro, erythro
57
microscopic appearance of legionela
gram negative (pink) rod/bacillus aerobic non spore forming
58
what causes mumps
- paramyxovirus | - RNA virus of the rubulavirus family
59
complications of mumps
* **- pancreatitis (abdo pain) - orchitis and redcued fertility - meningitis, encephalitis * **- sensorineural hearing loss
60
ix for ?mumps
- PCR testing of saliva swab | - blood/saliva antibody testing
61
transmission of mumps
- droplets of saliva | - kissing, sneezing, coughing
62
what causes pertussis
ie whopping cough | - bordetella pertussis- gram negative
63
ix for pertussis
- nasopharyngeal or nasal swab ---> PCR or bacterial culture | - if cough present >2w- antipertussis toxin immunoglobulin G (oral fluid or blood)
64
management of pertussis
- notify UKHSA - supportive - avoid contact with vulnerable people - macrolides-- azithromycin, ertyrho, clarithro - co-trimoxazole - should resolve within 2m
65
what causes yellow fever
- virus in genus flavivirus
66
locations where yellow fever is high
South america, sub-saharan africa - nigeria - brazil
67
vector of yellow fever
mosquito
68
sx yellow fever
- fevere, photophobia, headaches Acute phase - vomiting, fever !!!- headache, rigors, myalgia - anorexia toxic phase- occurs in next few days in 15% or people, half of whom die from shock - fever !!!- jaundice - haemorrhage (mouth, eyes, stomach) !!!- DIC !!!- renal function deterioration (prerenal or gomerulonephritis and intersitial nephritis)--> oedema - hypothermia
69
what is haemolytic uraemic syndrome
- due to E.coli shiga toxins, also produced by shigella - antimotility meds eg loperamide during infection of these pathogens increases the risk - thrombosis within small BVs - platelets consumption - thrombotic microangiopathy - high bleed risk
70
sx HUS
- haemolytic anaemia - thrombocytopania - AKI AKI - reduced UO - haematuria, dark brown - lethargy, confusion - vomiting - oedema - HTN THROMBO - bloody diarrhoea - abdo pain - bruising - fever, rigors, headache - note: jaundice is rare - often children <5yo
71
ix ?HUS
- FBC, clotting, LFTs, UE - peripheral blood smear show signs of RBC injury/haemolysis- schistocytes, RBC fragments - stool culture- shiga toxin - urinalysis
72
tx of HUS
- supportive - dialysis - anti HTN - fluid balance - blood - renal transplant - avoid abx, antimotility agents, NSAIDs
73
name some aminoglycosides
gentamicin | streptomycin
74
name some cephalosporins
'cef-'
75
name some penicillins
'-cillin'
76
name some tetracyclines
-cycline tetracycline doxycycline
77
name come (fluoro)quinolones
-floxacin ciprofloxacin levofloxacin ofloxacin
78
name some macrolides
- mycin erythromycin clarithromycin azithro
79
name some sulphonamides
sulfalazine sulphmethoxazole sulfadiazine
80
names some glycopeptides
vancomycin
81
what is augmentin
co-amoxicillin
82
what are some important things to consider when px aminoglycosides
gent, streptomycin !!!!- must be taken IV !!!!!- usage should not exceed 7 days where possible - nephrotoxic - weight dosed and monitored using normogram
83
SE of aminoglycosides
- ototoxicity - aphonia - GI upset - nephrotoxicity - skin reactions
84
what are some things to consider when using carbapenems
eg meropenem - beta lactam ring in structure- be careful in those with penicillin allergy - imipenem is broken down by enzyme in the kidney, so is given with cilastatin (enzyme inhibitor), to block this renal metab - v broad spec- often used in sepsis and severe/resistant infections
85
SE carbapenems
- GI * *- skin reactions * *- seizure inducing (rare) - pancytopenia
86
things to consider when givign cephalosporins
- do NOT give in pen allergic patients * ****- accumulate in renal impairment as are excrete renally - may cause c.diff * ***- may cause false positives on coombs test
87
things to consider when giving glycopeptides
- used in MRSA clearance - vanc should not be given PO as will not be absorbed (give IV) - vanc needs plasma conc monitoring - dont infuse too quickly
88
glycopeptide SEs
- otoxicity - nephrotoxicity - skin reactions - red man syndrome if given too quickly
89
things to consider when giving macrolides
- similar spectrum to penicillins- good alterative in pen allergic pts - erythro safest in pregnancy - clarithro+statin interaction - clarithro- increase digoxin tox risk - dose adjust in renal impairment
90
SE of macrolides
- QT prolongation * **- worsening of MG - GI * **- hearing impairment - skin reactions
91
things to consider when giving penicillins
- some may be inactivated by beta-lactamases (fluclox isnt) - allergy - co-amox is amox with clavulanic acid which is a lactamse inhibitor
92
SE penicillines
- hypersensitivity - GI - abx- related colitis - amoxicillin- skin reaction in EBV (and CMV, CLL) -
93
SE and CI or fluoroquinolones
``` Cipro, levo - GI - skin !!!!- seizures - tendon damage/rupture! increased risk if also on steroids !!!- heart valve regurg !!!- photosensitivity - QT prolongation ``` CI - QT prolongation - tendon disease hx with quinolones - epilepsy/seizure disorders - reduced dose in renal impairment
94
things to consider when givign tetracyclines
- NOT in pregnancy | - broad spec
95
SE tetracyclines
- worsen SLE - worsen MG - GI - skin reactions - photosensitivity
96
causes of neutropenic sepsis
Gut microorgs: - e/coli - klebsiella - pseudomonas
97
pts t risk of neutropenic sepsis
5-10d post chemo can occur months afterwards immunosup therapy
98
tx neutropenic sepsis
- 1st- IV tazocin (+gent) - 2- ceftazidime - 3- meropenem - paracetemol - fluids
99
tx skin infections
mild- fluclox (clarithro/doxy/erythro if allergic) mod/severe - fluclox +- gent +- metronidazole IV - pen allergy- co-trimoxazole +- gent +- metronidazole IV - if pseudomonas- IV tazocin + cipro - if MRSA- add vanc/teic or 2. linezolid IV
100
tx impetigo
Localised non bullous, well: 1- hydrogen peroxide 1% cream 2- TOP fusidic acid Widespread non bullous/bullous/unwell 1- PO fluclox (pen allergy- clarithro/erythro)
101
tx cellulitis/erysipelas
PO/IV - fluclox - allergy- clarithro/erythro/doxy near eyes/nose- PO/IV - co-amox - allergy- clarithro + metronidazole severe- PO/IV - co-amox - Add IV vanc if ?MRSA
102
tx secondary infeciton of eczema
- TOP fusidic acid | - PO fluclox (clarithro/erythro)
103
tx of osteomyelitis/septic arthritis
- fluclox, (+-fusidic acid/rifampicin for oesteomyelitis) - clindamycin (+- as above) - MRSA- + vanc/teic - septic arthritis-- flucloxacillin, clindamycin if allergic.. if ?gonococcal/gram -ve-- cefotaxime/ceftriaxone
104
tx eye infections (and micro cause)
- often causesd by staph aureus, strep pneumonia, h influenzae 1. chloramphenicol trachoma- azithromycin PO
105
micro cause of otitis externa
staph aureus | P.aeruginosa
106
structure and stain of s aureus
gram positive (purple) cocci spherical
107
tx otitis externa
- fluclox - clarithro/azithro/erythro if allergic/preg - if pseudomonas- cipro or aminoglycoside (eg gent)
108
micro causes of otitis media
H influenzae, strep pneumonia, strep pyogenes | can be viral (RSV, rhinovirus, adeno, influenzae, parainfl.)
109
tx otitis media
1. amoxicillin (clarithro/erythro) | 2. co-amox-- worsening sx despite 2-3d of 1st line
110
tx sinusitis
1. phenoxymethylpenicilline 2. co-amox severe/hgih risk 1. co-amox pen allergy- doxy, clarithro, erythro
111
sore throat/tonsillitis tx
Fever PAIN score strep - penicillin V (phenoxymethylpen) - clarithro/erythro if pen allergy
112
tx exacerbation of COPD
1. amox/clarithro/doxy PO 2. try other of 1st line didnt try, after 2-3 no improvement severe- IV amox, co-amox, clarithro, co-trimoxazole, taz
113
tx bronchiectasis
PO amox, clarithro, doxy severe- IV coamox, Taz, Levofloxacin similar to acute COPD exac
114
drugs that cause c.diff
- clindamycin - cephalosporins - quinolones (eg cipro) - wide spectrum abx eg tazocin - PPIs!
115
structure and histo appearance of c.diff
- gram positive - anaerobic - rod/bacillus - spore forming (resistant to cleaning)
116
complications of c.diff infection
- pseudomembranous colitis - toxic megacolon (avoid anti-diarrhoeals) - perf - sepsis
117
ix c.diff
stool sample: - exotoxins- A and B - glutamate dehygrogenase
118
tx c.diff
1st episode- PO vanc, then fidamoxicin - other episode within 12w- PO fidamoxicin - Other episode after 12w- PO either vanc of fidamoxicin - severe- PO vanc with IV metronidazole
119
tx H.pylori
PO 1st line- 7 days - PPI+amox+ clarithro/metronidazole - pen allergy- PPI + clarithro + metronidazole PO 2nd line- 7 days (if ongoing after 1st line) - PPI + amox + metronidazole/clarithro (whichever not used 1st line) - pen allergy- PPI + metronidazole + levofloxacin can also try levofloxacin or tetracycline
120
tx mild acute diverticulitis
- co-amox PO | pen allergy-**** trimethoprim + metro
121
tx severe/complicated diverticulitis
- coamox IV OR cefuroxime + metro | - pen allergy- cipro + metro
122
tx peritonitis
- cephalosporin + metro - gent+ metro or + clinda - taz assoc with peritoneal dialysis- vanc/teic + ceftazidime added to dialysis fluid
123
tx bacterial vaginosis
PO metronidazole 7 days | topical metro/clinda 7 days
124
tx chlamydia
azithro 1g one dose/doxy BD 7 days erythro 14d
125
tx gonorrhoea
- IM ceftriaxone - cipro if sensitive - IM gent + PO azithro
126
tx PID
14 doxy + metro, + stat IM ceftriaxone
127
tx syphilis
- benzathine benzylpenicillin - pen allergy- doxy/erythro - asx contacts- doxy
128
histological appearance of chlamydia
chlamydia trachomatis (and chlamydia pneumoniae - gram negative - aerobic - intracellular - coccoid or rod-shaped
129
histological appearance of gonorrhoea
- Neisseria gonorrhoeae - gram negative - coffee bean shaped - intracellular - diplococcus
130
histological appearance of syphillis and stains used
Teponema pallidum ``` (blood test, exudate swab from sore) - spirochete- spiral shaped - gram negative - worm like Staining: - Giemsa staining - Silver impregnation stain - Ryu's stain ```
131
microorganism cause of spontaneous bact peritonitis
gram negative bacilli - E.coli- most common - Klebsiella- second most common Gram positive cocci - strep spp - enterococcus - staphs pp
132
stages of HIV
seroconversion/primary/acute - up to 6 w post infection - flu like - most infectious asx - can last several years - virus is active, damagng immune system, replicating Sx - secondary infections, cancers - wt loss - night sweats - lympadenopathy - diarrhoea - fatigue, malaise - dry mouth, thrush, gingivitis, ulcer,s herpes, canker Later stage - AIDS - penumonia- TB, PCP - Kaposi's- cancer of lymph and blood vessels - invasive cervical cancer - non-hogkins
133
pathophysio of HIV
human immunodeficiency virus - member of lentivirus (retrovirus) - attacks CD4 lymphocytes (t helpers) - transmitted via blood, semen, vaginal fluid, anal mucus, breast milk
134
what is AIDs
CD4 count <200 | AIDs defining illnesses
135
ix ?HIV
- CD4 count - 3rd gen antibody test- blood, oral fluid, urine, only after seroconversion stage (3m post exposure) - 4th gen combined antigen/antibody test- reliable from 1m post exposure
136
management of HIV
- condom use - PrEP- pre-exposure prophylaxis-antiretrovirals- emtricitabine with tenofovir disoproxil - Post-exposure prophylaxis after sexual exposure (PEPSE)- 24hours after exposure, MUSt be withinin 72hours, 28d course, emtricitabine with tenofovir disoproxil + raltegravir - Highly active antiretrovial therapy (HAART)- stops replication and reduces viral levels- eg nucleoside reverse transcriptase inhibis, non-nucleoside reverse transcriptase inhibis, protease inhibis, integrase strand transfer inhibis
137
micro causes of infective endocarditis
most commonly gram positive cocci bacteria - staph aureus - viridans strep - enterococci Rarely - e/coli or pseudomonas aeruginosa - candida, aspergillus
138
red flag sx for infective endocarditis
- new murmur in feverish pt - splinter haemorrhages - Osler's (red, tender nodules on digits) - Janeway- macular red non tender lesions on palms/sole * **- Roth spots on fundoscopy
139
what criteria is used for infective endocarditis, what is in it
Duke's 2 majors/1major + 3 minors/5 minors major - 2x blood cultures- viridans strep, strep bovis, staph aureus, enterococci - echo minor * **- predisposing factor- heart cond, IVDU * **- fever - vasc phenomenon- janeway, embolism - immune phenomena- roth, oslers, glomerulonephritis - 1x blood culture/atypical organism
140
tx endocarditis
- 6w- abx depending on cause - prosthetic valve-- empiric- vanc, gent, (meropenem) - streptococcus- penicillin/ceftriaxone - native- (ampicillin+gent +fluclox or) vanc plus gent surgery to remove vegetation/replace valves/remove emboli elsewhere drainage of cavities pacemaker insertion stroke rehab
141
micro cause of rheumatic fever
- group a haemolytic strep (strep pyogenes)
142
strep pyogenes histo appearance
- gram positive purple - cocci (round, chains) - group b haemolytic - group A lancefield
143
sx rheumatic fever
- fever - carditis (endo, peri, myo)- tachycarida, murmur, pericardial rub, cardiomegaly, chest pain * **- arthritis- fleeting, migratory, large joints * ***- erythema marginatum (red, raised edge rash with clear centre), usually over joints and spine - chorea
144
ix rheumatic fever
- ESR/CRP - blood cultures - throat swabs - antigen test and titres - pr prolongation
145
diagnostic criteria for rheumatic fever
Jones strep infection plus 2 major criteria/ 1 major 2 minor: - major- carditis, arthritis, ***nodules/erythema, chorea - minor- **fever, rasied CRP/ESR, prolonged PR interval
146
management rheumatic fever
- bed rest until CRP normal - benxylpen or phenoxymethylpenicillin - corticosteroids - analgesia - immobilisation of joints if severe - diuretics/ACEI if in HF - daily PO penicillin for at least 5 years or up to 21yo to prevent recurrence and chronic rheumatic heart disease
147
what causes malaria
parasitic protazoa - plasmodium falciparum - plasmodium vivax - plasmodium ovale - plasmodium ***malariae - plasmodium knowlesi
148
tx malaria
Falciparum - artesunate - quinine - ******artemisinin combination therapy/artemether + lumefantrine/ atovaquone-proguanil - quinine + doxy non - falciparum - chloroquine - primaquine- prevents relapses, check for G6PD deficiency
149
prevention of malaria
when travelling to Africa, Asia, the Indian subcontinent, South America and some areas in the Far and Middle East. (The risk is particularly high in sub-Saharan Africa.) - proguanil and atovaquone (malarone) - mefloquine - doxy
150
name some obligate intracellular bacteria
- rickettsia- cause typhus, rockly mountain/brazilian/Mediterranean spotted fever - chlamydia - coxiella - have to be cultured in cells/cant be cultured- have to do PCR
151
list gram positive bacteria (purple/blue)
- Staphlococcus (cocci,/round, clusters) - streptococcus (cocci, chains) - enterococcus - corynebacteria - clostridia eg tetanus
152
what does coagulase positive and negative mean
Way of classifying staphlococcus: coag positive- Staph aureus coag negative- other staph eg staph epidermis, staph saprophyticus
153
how are streptococci classified
haemolytic type (culture on red blood cell plate) Lancefield typing- carbohydrate cell surface antigen grouping
154
list gram negative bacteria (pink)
Gammaproteobacteria - Enterobacteria (coliforms) - Vibrio - Pseudomonas - haemophilus - legionella Betaproteobacteroa - boredetella - Neisseria Epsilonproteobacteria - campylobacter - H.pylori Chlamydia Spirochetes
155
name some enterobacteria
- Eschericha coli - shigella - salmonella - proteus mirabilis - klebsiella - yersinia
156
structure of enterobacteria
- gram neg - rods/bacillus - covered in peritichous flagella (motile) - anaerobic
157
structure of campylobacter
- srpial rods - flagella - gram neg
158
structure of H/pylori
- require CO2 (microaerophilic) - spiral shaped - tuft of polar flagella
159
what is diptheria caused by
- corynebacterium diptheriae (gram positive, polymorphic) | - diptheria toxin- causes pharyngitis and pseudomembran ein the throat (white)
160
sx diptheria
- sore throat, dysphagia - pseudomembrane, can block airway and produce barking like cough - lymphadenopathy - may involve eyes, skins, genitals
161
tx diptheria
- vaccine in childhood - diptheria antitoxin - metronidazole/erythro/benzylpen
162
cause of rabies
- lyssavirus - bite wound of animals usually in SE asia - causes brain inflam
163
sx rabies
- hypersal - fever - furious sx- anxiet, confusion, agression, ecxitement, halluc, hyper, violent, hydrophobia - paralytic sx- weakness, loss of sensation, paralysis
164
ix rabies
- fluorescent antibody test - serology screen for other encephalitis causes - CT head
165
tx rabies
- vaccine - wash wound under runnign water for 15min - iodine - IVIG immediately
166
tetanus cause
clostridium tetani wound infection - soil dwelling - gram negative rod - releases toxins causing muscle spasms
167
sx tetanus
- lockjaw/trismus - spasms progress ****down the body - can break bones - fever, sweating, headache, dysphagia - HTN, tahcycardia
168
ix tetanus
- clinical | - spatula test- attempt illicit gag reflex pt will bite down involuntarily
169
management tetanus
If pt has had full course of vaccine (5 doses) within that last <10 years - no vaccine or tetanus Ig needed, regardless of wound severity Pt has had full course >10yrs ago - tetanus prone wound- reinforcing vaccine dose - high risk wound- vaccine plus Ig vaccination hx is incomplete/unknown- * **- vaccine dose in clean wounds - vaccine dose and Ig in tetanus prone and high risk tetanus prone= - injury in contaminated environment (eg gardening) - wound containing foreign body - compound # - systemic sepsis - animal bites/scratches high risk=any of the above plus: - soil, manure - devitalised tissue - any requirement of surgical intervention delayed >6hrs - muscle relaxants - mechanical vent if required
170
cause of cholera
vibrio cholerae- gram negative, anaerobic cholera toxin spread thought contaminated water and food
171
sx cholera
profuse watery diarrhoea- 'rice water'- grey/brown vomiting, abdo pain muscle cramps
172
management of cholera
``` oral rehydration therapy/IV fluids PO vaccination (6m protection) doxy if severe ```
173
causes of food poisoning
- campylobacter jejuni- most common (raw or undercooked poultry or something that touched it.)- dysentery - E.coli- (meat, milk) may cause dysentery - salmonella (meat, eggs )- dysentery * *- norovirus (Care home!) - bacilius cereus- rice, meat * *- clostridium botulinum- fish, meat - Listeria- pate, cheese - Shigella- eggs, salads * *- S aureus- dairy, meat - yersinia- milk, poultry
174
histo appearance of campylobacter jejuni
- gram negative - spiral shaped/curved/rod - vibrio
175
what causes bloody diarrhoea
- campylobacter- meat (raw/undercooked) * ***- shigella - salmonella- animal products - some strains of e.coli- water, food, hand to mouth * **- HUS * ***- C-diff- abx/person to person ****- amoebiasis- tropical location - intussusception - infant- NEC - mesenteric ischaemia/colitis * **- IBD flare - diverticulitis - cancer
176
what organism causes scarlet fever
strep pyogens (group A streptococcus, b haemolytic )
177
sx scarlet fever
- flu like sx - rash- small raised red bumps, rough - starts centrally and then spreads to peripheries - strawberry tongue- red, swollen, bumps, white coating
178
ix scarlet fever
- cinical - throat/tongue swabs - bloods- antistreptolysin
179
management of scarlet fever
- phenoxymethylpen/amox/ azithro/erythro - antipyretics - analgesia - fluids - notify
180
sx streptococcal toxic sock syndrome
strep pyogens/group A strep - more severe that staph aureus toxic shock - diffuse erythroderma - desquamation (palms, soles) - fever - hypotension, shock - organ failure (D+V, myalgia, AKI, hepatitis, thrombocytopenia, confusion)
181
tx of strep toxic shock syndrome
- aggressive fluid management - ventilate - renal replacement therapy - inotropes - cephalosporins, penicillins, vancomycin - clinda or gent - IVIG
182
Causes of meningitis (bacterial) accoridng to age
0 - 3 months - Group B Streptococcus- agalactiae (most common cause in neonates) - E. coli - Listeria monocytogenes 3 months - 6 years - Neisseria meningitidis - Streptococcus pneumoniae - Haemophilus influenzae 6 years - 60 years - Neisseria meningitidis - Streptococcus pneumoniae > 60 years - Streptococcus pneumoniae - Neisseria meningitidis - Listeria monocytogenes Immunosuppressed - Listeria monocytogenes (- fungal- cryptococcus , Histoplasma, candida)
183
who should be screened for MRSA
- all pts havig elective surgery | - from 2011 all emergency admissions (still the case?)
184
tx of MRSA if identified as carrier
- mupirocin paraffin TDA 5 days in nose - chlorhexidine gluconate skin, OD 5 days - vanc, teic, 2.- linezolid
185
infection (lung) in 4w post transplant pt- likely organism
CMV
186
Bilateral conjunctivitis, bilateral calf pains and high fevers in a sewage worker suggests..?
``` LEPTOspirosis: - flu-like illness - pulmonary haemorrhage - conjuncitvitis, subconjunctival haemorrhage organ injury: - hepatitis, jaundice - AKI ``` - transmission- broken skin with urine of infected rodents--- farmers' / sewage workers
187
sx of enteric fever
- abdo pain - fever - rose spot macular rash
188
abx for human/animal bites
coamox
189
sx giardiasis
- watery diarrhoea - systemicaly well- apyrexial, SNT - may feel bloated/flatulence - induces/precipitates lactose intolerance! may be lasting after infeciton has cleared - malabsorption- steatorrhoea
190
transmission of giardiasis
- swimming/drinking river from river/lake - travel - MSM
191
ix giardiasis
- stool microscopy - stool antigen - PCR assays
192
tx giardiasis
metronidazole
193
sx pneumocystitis jiroveci
- immunosupressed - SOB, esp on exertion - lethargy - recurrent chest infections/HIV positive-- immunosupressed - no/dry cough - fever
194
signs of peumocystitis jiroveci
DESATS ON EXERTION!!! - clear chest on ausc - normal CXR, may show BL intersitisal pulm infiltrates
195
tx penumocystitis jiroveci
co-trimoxazole IV pentamidine if severe steorids if hypoxic
196
live attenuated vaccines
``` BCG MMR yellow fever shingles, chickenpox ***rotavirus oral polio ***oral typhoid oral diptheria ```
197
sx and signs of hep A
- flu like - RUQ pain- tender hepatomegaly - Jaundice-dark urine, clay coloured stools - joint pain cholestatic LFTs- raised bili, ALT/AST, normal or raised ALP
198
transmission of hep A
faecal-oral, often in institutions
199
tx of letospirosis
high dose benzylpenicillin/doxy
200
what two abx have a dilsulfiram like reaction to alcohol
metronidazole | cefoperazone (a cephalosporin)
201
what organism presents with fever an drash, and in pts with haematologucal conditions, may cause pancytopnia ?
Parvovirus B19
202
sx amoebiasis
travel related infection bloody diarrhoea profuse
203
sx shigella
bloody diarrhoea
204
what is Chagas' disease
ie American trypanosomiasis/sleeping sickness - parasite- Trypanosoma cruzi - transmitted via kissing bug - muscles changes - asymptomatic in most - erythematous nodule at site of infectin - periorbital oedema complications: - myocarditis--> dilated cardiomyopathy, arrhythmias - GI- megaoesophagus, megacolone- dysphagia and consti
205
management of Chagas' disease
- Azole or nitroderivatives (nifurtimox)
206
sx of AFRICAN trypanosomiasis/sleeoing sickness
parasite- Trypanosoma bruce, transmitted via fly sx - chancre- painless SC nodule at site of infection - fever (intermittent) - cervical lymph nodes - CNS - headaches, mood , meningoencephalitis
207
tx of African trypanosomiasis
- IV pentamidine, suramin | - IV melarsoprol if CNS
208
what drug tx should all people with CD4 <200 receive
high active anti-retroviral therapy ( eg nucleoside/tide reverse transcriptase inhibis, non-nucleosie reverse transcriptase inhibis, protease inhibis, integrase strand transfer inhibis) and PO co-trimoxazole
209
what is AIDS CD4 count
<200/mm3 CD4 count
210
differentiation of possible causes of food poisoning
S. aureus - market stool - 1-6hours incubation--very short compared to others - severe vomiting Camylobacter - most common - flu like illness - often bloody Salmonella - cramps, diarrhoea - animal products - bloody Bacillus cereus - watery - N+V - cooked foods left uncovered- rice, meats E.coli - traveller's - watery, bloody Clostridium perfringens - intense abdo cramps - non bloody diarrhoea Clostirdium botulism - weakness, double vision, diffucly speaking, swallowing, death - processed foods Giardia - prolonged non bloody diarrhoea - incubation of >7 days - lactose intol - travel
211
infective causes of diarrhoea
non inflammatory (watery) - rotovirus - norovirus - CMV - adeno - Ecoli - staph aureus - Bacillis cereus - cholera- rice water/grey-brown - giradia - cryptospoidium parvum Inflammatory (dysentry) - salmonella - Shigella - Campylobacter - E.coli - C.diff - yerinia - Entamoeba-Amoebic
212
tx typhoid fever
- cipro - Supportive therapy: hydration, nutrition, antipyretics etc. - May need surgery for bowel perforation - Hygiene and hand washing
213
typhoid fever transmission and cause
- contaminated water, faeco-oral Salmonella typhi
214
sx of typhoid fever
- weakness, fatigue - stomahc pain, diarrhoea, consti, perf - headache, cough - loss of appetite
215
diagnosis of tyhpid fever
stool sample for culture | DNA blood test
216
test for mumps
PCR of oropharyngeal swab | igM Ab in serum
217
decolonisation tx for MRSA
Nasal mupirocin and chlorhexidine wash
218
What are infections classically caused by coagulase -ve staphylococci?
hospital lines | prostheses
219
tx meningitis
IM benzylpenicillin in community pending hospital transfer if there is a non-blanching rash. - 2g of IV ceftriaxone twice daily (twice the standard dose to ensure CNS penetration) - cefotaxime and amox if <3m as risk of hyperbili with ceftriaxone in neonates!! - addition of IV amoxicillin in young/old patients to better cover listeria - IV aciclovir if viral encephalitis is suspected. - penicillin allergic - chloramphenicol - contacts- cipro (or rifampicin)
220
most common viral causes of meningitis
Enteroviruses such as: echoviruses coxsackie A and B poliovirus
221
most common viral cause of encephalitis
HSV
222
tests for TB
CXR Sputum- MC&S - microscopy staining with Ziehl Neelsen or auamine - culture on Lawenstein Jensen media Interferon Gamma release assays- not affected by BCG, but cannot tell between acitve/latent TB PCR for rapid results Mantoux- tuberculin skin test for screening of contacts

Finals (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions