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Year 4 PassMed Incorrect Qs > Infectious Diseases + GUM > Flashcards

Infectious Diseases + GUM Flashcards

1
Q

Features of Trichomonas vaginalis
1
2
3
4 pH?
5 Men?

Management?

A
  1. vaginal discharge: offensive, yellow/green, frothy
  2. vulvovaginitis
  3. strawberry cervix
  4. pH > 4.5
  5. in men is usually asymptomatic but may cause urethritis

oral metronidazole for 5-7 days, although the BNF also supports the use of a one-off dose of 2g metronidazole

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2
Q

Enteric fever (typhoid/paratyphoid)

pathogens?(2)

route?

Classic STEM 3!!

A

Typhoid by Salmonella typhi

paratyphoid - Salmonella paratyphi

faecal-oral route

  1. rose spots: present on the trunk in 40% of patients, and are more common in paratyphoid
    2.constipation: although Salmonella is a recognised cause of diarrhoea, constipation is more common in typhoid
  2. relative bradycardia
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3
Q

Complications of mumps
1- most common by far
2
3
4

A
  1. Ochritis (typically 5-5 days after)
  2. Pancreatitis ( the M in IGETSMASHED)
  3. Hearing loss- usually unilateral and transient
  4. Meningioencephalitis
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4
Q

Gas gangrene is caused by??
Pathogen-
gram-
feature-
also known as myonecrosis

what increases the risk

A

C. perfringens
+ve
Spore forming therefore quick onset 12 hours in question

blebs and bullae

peripheral vascular disease increases the risk

THIS IS DIFFERENT TO NECROTIZING FASCITITIS

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5
Q

BNF guidelines: Human bite or animal

how many days and imediate or delayed?

A

Co-amoxiclav

3 day course- immediate

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6
Q

monitoring treatment response in syphilis
an adequate response to treatment.=

A

Repeat serological tests and check for a four-fold decrease in nontreponemal titre

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7
Q

when would require admission for IV antibiotics in cellulotes? (3)

A
  • systemically unwell or
  • Diabetic
  • or peripheral vascular disease
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8
Q

classical description of mild/anicteric leptospirosis (3)

Management (1)

A

Bilateral conjunctivitis
bilateral calf pains
high fevers in a sewage worker suggests leptospirosis

Management
high-dose benzylpenicillin or doxycycline

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9
Q

Disseminated gonococcal infection triad =

Neisseria gonorrhoea, a gram-negative diplococcus

If ceftriaxone is refused? (1st line)(e.g. needle-phobic) (2)

A

tenosynovitis
migratory polyarthritis
dermatitis

oral cefixime 400mg (single dose) + oral azithromycin 2g (single dose) should be used

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10
Q

Infectious mononucleosis what are you at risk of and what should you avoid?

classic triad of presentation

pathogen? HHV….

diagnosis via…

Management
- supportive (2)
educate (2)

A
  • Splenic rupture

Avoid contact sports for 4 weeks

  1. sore throat
  2. pyrexia
  3. lymphadenopathy

HHV 4, EBV

Monospot test

Management
- fluid + simple analgesia
- rest in the early stages
- educate- no alcohol
- educate - no contact sport 4 wks

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11
Q

Other features of EBV

A

malaise, anorexia, headache
palatal petechiae
splenomegaly - occurs in around 50% of patients and may rarely predispose to splenic rupture
hepatitis, transient rise in ALT
lymphocytosis: presence of 50% lymphocytes with at least 10% atypical lymphocytes
haemolytic anaemia secondary to cold agglutins (IgM)
a maculopapular, pruritic rash develops in around 99% of patients who take ampicillin/amoxicillin whilst they have infectious mononucleosis

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12
Q

Chlamydia Management
first line- + how many days?
second line/ not tolerated-

If preg (3 options)

A

first line- 7 days doxycylin

second line/ not tolerated- 1g azithromycin

If preg (3 options)
- azithryomyin
- erythromcyin
- amxoacillin

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13
Q

What is Lemierre’s syndrome?

secondary due to infection form…

A

an infectious thrombophlebitis of the internal jugular vein.

secondary to a bacterial sore throat caused by Fusobacterium necrophorum leading to a peritonsillar abscess- present septic

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14
Q

HIV pateint with neuro deficits

multiple brain lesions =

Single lesion =

much more rare but single lesion could also be…

A

multiple brain lesions = Cerebral toxoplasmosis
caused by the parasite Toxoplasma gondii,

Single lesion = Lymphoma
Solid (homogenous) enhancement

Single lesion- TB

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15
Q

Lyme Disease

if patient is worried about it because of a tick bite what should you do?

How does it present? Classic STEM (1)

Management if you suspect/ confired diag?
early disease-
Alternative-
Disseminated disease

A
  • if asmpy then just reassure + safety net

STEM = ‘bulls-eye’ rash is typically at the site of bite

early disease- Doxycylin
Alternative- Amoxacillin (if preg)
Disseminated disease- Ceftriaxone

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16
Q

What are the contra-indications for receiving dexamethasone in meningitis? (5)

A
  1. Post-surgery
  2. If immuno-compromised
  3. Meningococcal septicaemia
  4. Meningitis septic shock
  5. < 3 months
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17
Q

What is the most frequent and most severe manifestation of chronic Chagas’ disease

A

dilated Cardiomyopathy (with apical atophy) and arrhythmias

Shaggas don’t fall in love = Chagas, cardiomyopathy

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18
Q

When you have had your spleen removed what 2 pathogens are you at risk of contracting?

A
  • Strep pneumonia (therefore get vaccine)
  • H. influenza
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19
Q

Tetanus prophylaxis when have a wound

Patient has received all 5 vaccines and last dose < 10 years ago….

Patient has received all 5 vaccines and last dose >10 years ago….
tetanus prone wound then—
high risk wound —

Patients with an uncertain on tetanus vaccination history should be given (2)

Unless… (2)

A

< 10 years ago- no booster vaccine or immunoglobulin is required regardless of wound severity

? 10 years-
tetanus prone wound then— booster vaccine
high risk wound — booster + immunoglobulin

vaccine history unknown
booster vaccine + immunoglobulin regardless of wound severity

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20
Q

the most common cause of travellers’ diarrhoea

A

E. coli

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21
Q

What should be considered in the presentation of dysentery after a long incubation period??

A

Amoebiasis

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22
Q

Metronidazole Adverse effects (2)

A
  1. disulfiram-like reaction with alcohol
  2. increases the anticoagulant effect of warfarin Cytochrom p450 inhibitor
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23
Q

A history of Intravenous drug use coupled with a descending flaccid paralysis, diplopia and bulbar palsy is characteristic of infection with

A

Clostridium botulinum

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24
Q

Hepatitis A presents with (5)

A

flu-like symptoms, RUQ pain, tender hepatomegaly and deranged LFTs, jaundice

25
Q

genital herpes: Management

how is it managed in preg? (2)

A

oral aciclovir. Some patients with frequent exacerbations may benefit from longer term aciclovir

preg
- elective c- section at term is advised if a primary attack of herpes occurs during pregnancy at greater than 28 weeks gestation
- recurrent herpes who are pregnant should be treated with suppressive therapy and be advised that the risk of transmission to their baby is low

26
Q

Progressive multifocal leukoencephalopathy is caused by the virus (2)

A

JC virus and BK virus in some occasions.

27
Q

stages of syphilis

Primary (2)
- Normally don’t see in…

Secondary - after how long? (4)

A

Primary
1. chancre - painless ulcer at site of sexual contact
2. local non-tender lymphadenopathy
- often not seen in women (the lesion may be on the cervix)

Secondary - 6-10 weeks
1. systemic symptoms: fevers, lymphadenopathy
2. rash on trunk, palms and soles
3. buccal ‘snail track’ ulcers (30%)
4. condylomata lata (painless, warty lesions on the genitalia )

28
Q

Syphilis continued…

Tertiary presentation (5)

Congenital 6

A

Tertiery
1. gummas (granulomatous lesions of the skin and bones)
2. ascending aortic aneurysms
3. general paralysis of the insane
4. tabes dorsalis- progressive degen of dorsal column neuro
5. Argyll-Robertson pupil- bilateral small pupils which don’ t react to light

Congenital 6
1. blunted upper incisor teeth (Hutchinson’s teeth), ‘mulberry’ molars
2. rhagades (linear scars at the angle of the mouth)
3. keratitis
4. saber shins (bowing of shins)
5. saddle nose
6. deafness

29
Q

UTI in breast feeding mum what abx?

what if allergic?

A

Trimethoprim is present in milk but is not known to be harmful for short term use. This would be an appropriate choice.

Nitrofurantoin should be avoided when breastfeeding - small amounts in milk but can cause haemolysis in G6PD infants.

30
Q

UTI in breast feeding mum what abx?

what if allergic?

A

Trimethoprim is present in milk but is not known to be harmful for short term use. This would be an appropriate choice.

Nitrofurantoin should be avoided when breastfeeding - small amounts in milk but can cause haemolysis in G6PD infants.

31
Q

Leishmania
spread by?

there is 3 types

  1. Cutaneous leishmaniasis- pathogen Leishmania tropica or Leishmania mexicana
    - Looks like?
    - Diag via?
  2. Mucocutaneous leishmaniasis- Leishmania braziliensis
    - Where?
  3. Visceral leishmaniasis (kala-azar)- caused by Leishmania donovani
    - where?
    - STEM looks like/ presents (4)
    - gold standard diag?
A
  • the bites of sandflies
  1. Cutenous = crusted lesion +/- underlying ulcer usually on hand. Diag via punch biopsy
  2. Mucocutaneous = skin lesions may spread to involve mucosae of nose, pharynx etc
  3. Visceral -
    where?
    Mediterranean, Asia, South America, Africa
    STEM
    - fever, sweats, rigors
    - massive splenomegaly. hepatomegaly
    - grey skin - ‘kala-azar’
    - Weight loss can be poor diet or paradoxical increase apetite

gold standard for diag- bone marrow or splenic aspirate

32
Q

Ulceration of the penis

painless ulcer + painless inguinal lymphadenopathy =

painful ulcer =

Painful inguinal lymphadenopathy =

A

painless ulcer = Treponema pallidum/ SYPHILIS
painful ulcer = Haemophilus ducreyi
Painful inguinal lymphadenopathy = Lymphogranuloma venerum

33
Q

Syphilis pathogen =

incubation period?

A

Treponema pallidum

  • 9-90 days
34
Q

Post -exposure prophylaxis

HIV and needle stick injury what should you do? (2)

When can it not be started?

Does a human bite need pro-exposure prophylaxis?

A

4 weeks of antiretroviral therapy (start within ASAP within 1-2 hours, 24 hours) and arrange HIV testing at 12 weeks

  • beyond 72 hours of exposure

Bite- generally does not

35
Q

H0w does yellow fever present?

  1. …. then…
  2. …. then….
  3. (2)

spread by?

incubation period

STEM - What might be seen in hepatocytes?

A
  1. flu like illness then… + Bradycardia may develop!!
  2. brief remission then…
  3. jaundice (hepatitis) and haematemesis

Aedes mosquitos

2-14 days

Councilman bodies (inclusion bodies) in hepatocytes?

36
Q

UTI who should send of MCU? (5)

A
  1. every woman > 65yo
  2. Preg
  3. Male
  4. ALL!!! woman with visable or non-visable haematuria
  5. Recurrant UTI (2 in 6 months or 3 in 12)
37
Q

URTI symp and then give amoxacillin thinking tonsilits but a rash breaks out, across the chest, what are thinking?

A

Epstein-Barr virus

triad of sore throat, pyrexia, and lymphadenopathy.

38
Q

difference in lympadenopathy in EBV and tonsillitis?

A

EBV- anterior and posterior triangles
Tonsilitis- only results in the upper anterior cervical chain

39
Q

schistosomiasis haematobium parasite

STEM- where/ how?

how does it enter?

Chronic infection presents how? (1)

Gold standard diagnostic test?

Management
- Single does of…

A
  • STEM- ‘swimmer’s itch’ in patients who have recently returned from Africa

penetrating through the skin, often causing a local skin hypersensitivity reaction

  • Haematuria/ urinary symp due to parasite laying eggs in venous plexus of bladder therefore pissing out the eggs
  • Stool and urine microscopy

Management
- Single dose of… praziquantel

40
Q

Name the Live attenuated vaccines (5)

A
  • MMR
  • BCG
  • Oral polio
  • Yellow fever
  • Oral typhoid

MY

BT

Password- polio

41
Q

How do you screen for HIV? (2)

A

Combination tests (HIV p24 antigen and HIV antibody) are now standard for the diagnosis and screening of HIV

p24- turn out positive between 1 and 4 weeks
Antibody- turn out positive between 4 weeks and 3 months

42
Q

First line treatment for early Lyme disease is + length of time

  • If 1. is CI?

Management of disseminated disease?

A

14-21 day course of oral doxycycline

If CI (preg) then amoxacillin

ceftriaxone if disseminated disease

43
Q

Deterioration in patient with hepatitis B - ?

A

hepatocellular carcinoma

44
Q

Alpha- haemolytic strep aka?
Infections it causes:
complete or partial haemolysis?

Beta- haemolytic strep
Partial or partial haemolysis?
Group A =
Infections it causes: (4)
Group B =
Infections it causes: (1)
Group D =

A

Alpha- Strep Pneumoniae
(Also strep Vidirans)
1. Pneumonia
2. Meningitis
3. otits media
Partial haemolysis

Beta- haemolytic strep
Complete haemolysis

Group A = Strep pyognes
Infections it causes: Tonilitis, cellulitis, Type 2 Nec fascititis, Erysipales

Group B = Streptococcus agalactiae Infections it causes: neonatal meningitis and septicaemia

Group D = Enterococcus

45
Q

How do you diagnose mycoplasma pneumonia?

A

serology is diagnostic

46
Q

E.coli
Gram and cocci or rod?

3 infections it can cause?

strain associated with HUS?

This strain is from?

A

-ve rod

  1. Neonate meningitis
  2. UTI
  3. Diarrhoeal illnesses

E. coli O157:H7

contaminated ground beef.

47
Q

Hwow do you surpress MRSA from a carrier once identified? (2)

A
  1. nose: mupirocin 2%, tds for 5 days
  2. skin: chlorhexidine gluconate, od for 5 days. Apply all over but particularly to the axilla, groin and perineum
48
Q

BV
STEMs (2)

How do you treat BV?
Asymp=
Symptomatic=
(+ Alternative route)
Preg=
Breast feeding = what is CI?

A
  • Fishy green disachrge
  • Clue cells

Asymp= treatment is not usually required
Symptomatic= 400mg (low dose) oral metronidazole for 5-7 days
- single oral dose of metronidazole 2g may be used if adherence

Preg= oral metronidazole is used throughout pregnancy

Breast feeding = High stat doses of 2g metronidazole is contraindicated in breastfeeding

49
Q

Management of toxoplasmosis in immuno-competenet

If immuno-suppressed (2)

A
  • no treatment
  • Suppressed- Pyrimethamine and sulphadiazine
50
Q

Otits externa

2 common pathogens cause it, how would lab features differentiate?

  1. ## Name--
    -
  2. ## Name
A
  1. Pseudomonas auriginosa
    -Gram-negative rod
    - non-lactose fermenting
    - oxidase positive
  2. Staph Aureus
    - Gram ve cocci
51
Q

Draw out the table for CSF meningits

Bacterial
Viral
TB
Fungal

opening pressure
Appearance (STEM for TB)
Glucose
Protein
White cells

A

Bac
opening pressure- high
Appearance- cloudy
Glucose- low (<1/2 of plasma)
Protein- high (>1g/l)
White cells- 10-5000 polymorphs

Viral
opening pressure- normal
Appearance- cloudy. clear
Glucose- normal
Protein - normal/ raised
White cells - 15-1000 lymphocytes

TB
opening pressure- high
Appearance- Slighty cloudy, fibrin web
Glucose- low (<1/2 of plasma)
Protein - High (> 1 g/l)
White cells - 30 - 300 lymphocytes

fungal
Appearance - cloudy
Glucose- low
Protein - high
White cells - 20 - 200 lymphocytes

52
Q

At what CD4 count do you commonly get pneumonitits jrvecci?
and receive prophylaxis

What is given for prophylaxis?

A

< 200

Co-trimoxazole

53
Q

most common pathogen causing pyelonephritis is

A

E. coli

54
Q

Which hepatitis have no vaccine?

A

Hep C, D, E

A and B do

55
Q

Aspergilloma
- who does it present in and why?

6 predisposing conditions

CXR STEM (1)

A
  • Immuno-surpressed (taking steroids)

People with previous caviating disease where the aspergillous will form:
TB, sarcoidosis, bronchiectasis, and ankylosing spondylitis, lung cancer or cystic fibrosis

  • See caviating lesion on CXR with crescent sign present
56
Q

grey coating is seen surrounding the tonsils, bulky cervical lymphadenopathy (‘bull neck’)think

Management (2)

A

Diphtheria

  1. intramuscular penicillin
  2. diphtheria antitoxin
57
Q

Genital wart treatment
multiple, non-keratinised warts:
solitary, keratinised warts:

caused by HPV… (2)

A

multiple, non-keratinised warts: topical podophyllum

solitary, keratinised warts: cryotherapy

HPV 6 & 11.

58
Q

What are the faecal oral hepatitis?
What are the Blood and sexually transmitted?

A

Vowels and bowels - AE
B and C for blood and cum

Year 4 PassMed Incorrect Qs (37 decks)

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