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MRCP 1 > infectious diseases and STIs > Flashcards

infectious diseases and STIs Flashcards

1
Q

Organisms splenectomy patients are at risk from

A

pneumococcus, haemophilus, meningococcus and Capnocytophaga canimorsus (usually from dog bites)

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2
Q

splenectomy vaccinations needed and prophylactic Abx

A

Hib,
meningitis A and C
annual influenza
pneumococcal vaccine every 5 yrs

penicillin V

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3
Q

Leishmaniasis - type of organism involved, mode of spread, forms of the disease

A 
intracellular protazoa
sand fly
cutaneous (mexicana)
mucocutaneous (brasiliensis)
visceral (donovani)
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4
Q

multiple ring enhancing lesions seen on CT of HIV+ pt. Dx? Mx?

A

toxoplasmosis
most common neurological infection in HIV pts
Mx - pyrimethamine and sulfadiazine

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5
Q

features of severe malaria

A 
schizonts on blood film
temp >39
parasitaemia >2%
severe anaemia
hypoglycaemia
cerebral malaria - seizures, coma
acute renal failure
ARDS
DIC
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6
Q

main organism responsible for bacterial vaginosis

A

gardnerella vaginosis (anaerobic)

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7
Q

Mx of bacterial vaginosis

A

oral metronidazole for 5-7 days,
more than half relapse in 3 months
topical metronidazole or clindamycin as alternatives

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8
Q

when do you start PCP prophylaxis in HIV pts?

A

when CD4 <200 (oral co-trimoxazole)

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9
Q 
Antibiotic therapies for meningitis:
at GP
hospital setting
hospital >50 and <3/12
pen allergic
A

IM benzylpenicillin - dont delay transport to hosp
IV cefotaxime
IV cefotaxime and amoxicillin
chloramphenicol

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10
Q

Management of meningitis contacts

A

offer prophylaxis to close contacts and housemates
oral rifampicin or ciprofloxacin
offer vaccine afterwards.

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11
Q 
TB meds side effects
Rifampicin
Isoniazid
pyrazinamide
ethambutol
A

Rifampicin - hepatitis, flu-like Sx,
isoniazid - peripheral neuropathy, hepatitis, agranulocytosis, Pellagra (B3 def)
pyrazinamide - hyperuricaemia –> gout, hepatitis
ethambutol - optic neuritis - check VA before and during treatment.

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12
Q

Listeria monocytogenes - typical spread, dangerous to who, management

A

multiply at low temperatures
typically spread via contaminated food
particularly dangerous to pregnant women - can lead to miscarriage
Mx: BCULT, Rx with amoxicillin/ampicillin

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13
Q

Management of tetanus

A

supportative inc muscle relaxants
IM human tetanus immunoglobulin for high risk wounds
IV metronidazole

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14
Q

symptoms of chlamydia

A

asymptomatic in 70% women and 50% of men

women: cervicitis (discharge, bleeding), dysuria
men: urethral discharge, dysuria

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15
Q

Ix and Mx of chlamydia

A

nuclear acid amplification tests (NAATs) - 1st pass urine, vulvovaginal/cervical swab
7 days doxycycline or single dose azithromycin, erythromycin if preg.

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16
Q

who do you contact if pt is found to have chlamydia

and what do you offer?

A

symptomatic men - partners in last 4 weeks
asymptomatic men and all women - partners from last 6 months
Test and treat prior to knowledge of results.

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17
Q

most common cause of infective diarrhoea in HIV pts
Ix
Mx

A

cryptosporidium (protozoa)
acid fast stain shows red cysts
Supportative management

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18
Q

what are the features of African trypanosomiasis (sleeping sickness)?
mode of spread?

A

trypanosoma chancre - painless nodule at site of infection
intermittent fever
posterior cervical chain LN enlargement
later CNS involvement - somnolence, headaches, meningoencephalitis

Tsetse fly

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19
Q

whats is Chagas’ diease?

features

A

trypanosoma cruzi protozoa infection
95% asymptomatic in acute phase
chronic infection causes myocarditis (HF and arrhythmias) and megaoesophagus and megacolon (dysphagia and constipation)

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20
Q

key features of:
trichomonas vaginalis
BV
candida

A

offensive yellow/green frothy discharge, vulvovaginitis

offensive thin grey fishy discharge

“cottage cheese” discharge, itchy

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21
Q

what type of hypersensitivity occurs in scabies infections

A

type IV - delayed cell mediated response

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22
Q

Mx of scabies infection

A

1st line: permethrin, repeat in 7 days
pruritis can persist for 4-6 weeks
treat all contacts and wash bed linen and towels on day 1

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23
Q

features of Lyme disease
early
late

A

borrelia burgdorferi
early: erythema chronicum migrans (papule at site of tick bite -> annular lesion with central clearing)
systemic symptoms: malaise, fever, arthralgia

late:
cardio: myocarditis, heart block
neuro: CN palsies, meningitis
polyarthritis

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24
Q

hep B serology seen in a previously infected pt (>6months ago)

A

anti HBs+ now immune. negative in chronic disease
anti HBc+ positive in current or previous infection
HBsAg - no current infection and not infectious (positive in HB carriers)

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25
Q

what is the cause of typhoid and paratyphoid?

A

salmonella typhi and paratyphi (types A, B &C)

26
Q

features of typhoid

A

systemic upset: fever, arthralgia, h/a
relative bradycardia
abdo pain, distention, constipation
Rose spots are pathognomonic (blanching pink, macular 2-3mm on trunk)

27
Q

features of Brucellosis
how is it Dx?
Mx?

A

malaise and fever, hepatosplenomegaly, sacroiliitis
brucella serology test
doxy and streptomycin

28
Q

what is the organism that causes syphilis

A

treponema pallidum

29
Q

mode of action of aciclovir

A

inhibits viral DNA polymerase

30
Q 
target of the monoclonal antibodies:
rituximab 
infliximab
trastuzumab 
cetuximab
A

rituximab - anti CD20 (Non-hodgkin’s and RA)
infliximab - anti TNF (RA and Crohns)
trastuzumab (Herceptin) - anti HER2 (breast ca)
cetuximab - epidermal GFr antagonist (met colorectal ca and h&n ca)

31
Q

Mx of trypanosomiasis?

A

Early: IV pentamidine or surine

If CNS involvement: melarsoprol

32
Q

what is the microscopic structure of gonorrhoea

A

gram negative diplococci

33
Q

what percentage of men and women are symptomatic with gonorrhoea?

A

90-95% of men

50% of women

34
Q

what is the Ix and Mx of gonorrhoea?

A

1st past urine NAAT (nuclear acid amplification test)

Mx IM ceftriaxone 500mg and azithromycin 1g PO, contact tracing, retest in 2 weeks.

35
Q

What contact tracing is needed for gonorrhoea?

A

symptomatic - sexual partners from last 2 weeks

asymptomatic - 3 months

36
Q

What is the most common STI

A

chlamydia, 2nd gonorrhoea.

37
Q

what percentage of men and women are symptomatic with chlamydia?

A

men 50%

women 20%

38
Q

complications of chlamydia

A

men: epididymitis, epididymo-orchitis
women: PID, tubal infertility, ectopic pregnancy

39
Q

Mx of chlamydia

A

single dose 1g azithromycin (erythromycin if preg) or 7 days 100mg doxycycline

40
Q

Ix and Mx of lyme disease

A

serology tests for antibodies to Borrelia burgdorferi
Mx: doxy if early, ceftriaxone if disseminated
Can have Jarish-Herxheimer reaction after starting Rx - fever rash tachy. also seen in syphillis.

41
Q

features and Mx of cutaneous anthrax

A

black eschar, marked oedema, typically painless and non tender

Mx:ciprofloxacin

42
Q

gram positive cocci

A

staph and strep (including entero)

43
Q

gram negative cocci

A

N.meningitis, N.gonorrhoea, moraxella

44
Q

what medication do you give for malaria prophylaxis?

A

atovaquone + proguanil (Malarone)

45
Q

risk of Hep B infection from needlestick of Hep B infected pt
Mx

A

20-30%
if had vaccine, give booster,
if not had vaccine - Hep B IG and vaccine

46
Q

Treatment of shigella

A

ciprofloxacin

47
Q

features of Dengue fever

Mx

A

h/a, fever,
low platelets, raised ALT
Mx: symptomatic

48
Q

Mx of toxoplasmosis in HIV patients

A

treat if CD4 count is <200

sulfadiazine and pyrimethamine

49
Q

Ix for malaria

A

3 x blood films
raised platelets
normochromic normocytic anaemia
normal WCC

50
Q

Features of loiasis

A

painful swellings of the limbs - angioedema with paraesthesia
leukocytosis and hypereosinophilia
conjunctival spread (eye worm)

Filarial infection caused by Loa Loa (central and western Africa)

51
Q

prevention of loiasis

A

weekly diethylcarbamazine citrate for prevention

52
Q

Most common skin condition in HIV pts

A

Eosinophilic folliculitis
Occurs when CD4 <300
Itchy papules and pustules on chest and arms

53
Q

Organism, symptoms and treatment of schistosomiasis

A

Schistosoma Haematobium
dysuria, frequency, haematuria (occasionally haemospermia), incontinence
Rx: oral praziquantel

54
Q

Features of HIV seroconversion illness

Ix

A

fever, malaise, arthritis
rash, sore throat
diarrhoea, lymphadenopathy
meningo-encephalaitis

Seroconversion period 2-3 weeks to 3 months.
Ix: P24 antigen and HIV RNA PCR.

55
Q

Amoebic dysentry:
features
Ix
Mx

A

fever (rarely high temps) abdo pain and diarrhoea. Stool may have blood or mucus in.
Ix: stool cultures and microscopy
Mx: oral metronidazole for 5 days then diloxanide furoate to destroy gut cysts.

56
Q

Mx of hookworm

A

Most common feature is iron deficiency anaemia

Mx with albendazole or mebendazole (antihelmintic)

57
Q

Inhibit cell wall formation Abx

A

penicillins

cephalosporins

58
Q

Inhibit protein synthesis Abx

A 
aminoglycosides (cause misreading of mRNA)
chloramphenicol
macrolides (e.g. erythromycin)
tetracyclines
fusidic acid
59
Q

Inhibit DNA synthesis abx

A

quinolones (e.g. ciprofloxacin)
metronidazole
sulphonamides
trimethoprim

60
Q

Inhibit RNA synthesis abx

A

rifampicin

MRCP 1 (15 decks)

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