Infectious Diseases + GUM Flashcards
Features of Trichomonas vaginalis
1
2
3
4 pH?
5 Men?
Management?
- vaginal discharge: offensive, yellow/green, frothy
- vulvovaginitis
- strawberry cervix
- pH > 4.5
- 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
Enteric fever (typhoid/paratyphoid)
pathogens?(2)
route?
Classic STEM 3!!
Typhoid by Salmonella typhi
paratyphoid - Salmonella paratyphi
faecal-oral route
- 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 - relative bradycardia
Complications of mumps
1- most common by far
2
3
4
- Ochritis (typically 5-5 days after)
- Pancreatitis ( the M in IGETSMASHED)
- Hearing loss- usually unilateral and transient
- Meningioencephalitis
Gas gangrene is caused by??
Pathogen-
gram-
feature-
also known as myonecrosis
what increases the risk
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
BNF guidelines: Human bite or animal
how many days and imediate or delayed?
Co-amoxiclav
3 day course- immediate
monitoring treatment response in syphilis
an adequate response to treatment.=
Repeat serological tests and check for a four-fold decrease in nontreponemal titre
when would require admission for IV antibiotics in cellulotes? (3)
- systemically unwell or
- Diabetic
- or peripheral vascular disease
classical description of mild/anicteric leptospirosis (3)
Management (1)
Bilateral conjunctivitis
bilateral calf pains
high fevers in a sewage worker suggests leptospirosis
Management
high-dose benzylpenicillin or doxycycline
Disseminated gonococcal infection triad =
Neisseria gonorrhoea, a gram-negative diplococcus
If ceftriaxone is refused? (1st line)(e.g. needle-phobic) (2)
tenosynovitis
migratory polyarthritis
dermatitis
oral cefixime 400mg (single dose) + oral azithromycin 2g (single dose) should be used
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)
- Splenic rupture
Avoid contact sports for 4 weeks
- sore throat
- pyrexia
- lymphadenopathy
HHV 4, EBV
Monospot test
Management
- fluid + simple analgesia
- rest in the early stages
- educate- no alcohol
- educate - no contact sport 4 wks
Other features of EBV
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
Chlamydia Management
first line- + how many days?
second line/ not tolerated-
If preg (3 options)
first line- 7 days doxycylin
second line/ not tolerated- 1g azithromycin
If preg (3 options)
- azithryomyin
- erythromcyin
- amxoacillin
What is Lemierre’s syndrome?
secondary due to infection form…
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
HIV pateint with neuro deficits
multiple brain lesions =
Single lesion =
much more rare but single lesion could also be…
multiple brain lesions = Cerebral toxoplasmosis
caused by the parasite Toxoplasma gondii,
Single lesion = Lymphoma
Solid (homogenous) enhancement
Single lesion- TB
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
- 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
What are the contra-indications for receiving dexamethasone in meningitis? (5)
- Post-surgery
- If immuno-compromised
- Meningococcal septicaemia
- Meningitis septic shock
- < 3 months
What is the most frequent and most severe manifestation of chronic Chagas’ disease
dilated Cardiomyopathy (with apical atophy) and arrhythmias
Shaggas don’t fall in love = Chagas, cardiomyopathy
When you have had your spleen removed what 2 pathogens are you at risk of contracting?
- Strep pneumonia (therefore get vaccine)
- H. influenza
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)
< 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
the most common cause of travellers’ diarrhoea
E. coli
What should be considered in the presentation of dysentery after a long incubation period??
Amoebiasis
Metronidazole Adverse effects (2)
- disulfiram-like reaction with alcohol
- increases the anticoagulant effect of warfarin Cytochrom p450 inhibitor
A history of Intravenous drug use coupled with a descending flaccid paralysis, diplopia and bulbar palsy is characteristic of infection with
Clostridium botulinum
Hepatitis A presents with (5)
flu-like symptoms, RUQ pain, tender hepatomegaly and deranged LFTs, jaundice
genital herpes: Management
how is it managed in preg? (2)
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
Progressive multifocal leukoencephalopathy is caused by the virus (2)
JC virus and BK virus in some occasions.
stages of syphilis
Primary (2)
- Normally don’t see in…
Secondary - after how long? (4)
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 )
Syphilis continued…
Tertiary presentation (5)
Congenital 6
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
UTI in breast feeding mum what abx?
what if allergic?
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.
UTI in breast feeding mum what abx?
what if allergic?
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.
Leishmania
spread by?
there is 3 types
- Cutaneous leishmaniasis- pathogen Leishmania tropica or Leishmania mexicana
- Looks like?
- Diag via? - Mucocutaneous leishmaniasis- Leishmania braziliensis
- Where? - Visceral leishmaniasis (kala-azar)- caused by Leishmania donovani
- where?
- STEM looks like/ presents (4)
- gold standard diag?
- the bites of sandflies
- Cutenous = crusted lesion +/- underlying ulcer usually on hand. Diag via punch biopsy
- Mucocutaneous = skin lesions may spread to involve mucosae of nose, pharynx etc
- 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
Ulceration of the penis
painless ulcer + painless inguinal lymphadenopathy =
painful ulcer =
Painful inguinal lymphadenopathy =
painless ulcer = Treponema pallidum/ SYPHILIS
painful ulcer = Haemophilus ducreyi
Painful inguinal lymphadenopathy = Lymphogranuloma venerum
Syphilis pathogen =
incubation period?
Treponema pallidum
- 9-90 days
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?
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
H0w does yellow fever present?
- …. then…
- …. then….
- (2)
spread by?
incubation period
STEM - What might be seen in hepatocytes?
- flu like illness then… + Bradycardia may develop!!
- brief remission then…
- jaundice (hepatitis) and haematemesis
Aedes mosquitos
2-14 days
Councilman bodies (inclusion bodies) in hepatocytes?
UTI who should send of MCU? (5)
- every woman > 65yo
- Preg
- Male
- ALL!!! woman with visable or non-visable haematuria
- Recurrant UTI (2 in 6 months or 3 in 12)
URTI symp and then give amoxacillin thinking tonsilits but a rash breaks out, across the chest, what are thinking?
Epstein-Barr virus
triad of sore throat, pyrexia, and lymphadenopathy.
difference in lympadenopathy in EBV and tonsillitis?
EBV- anterior and posterior triangles
Tonsilitis- only results in the upper anterior cervical chain
schistosomiasis haematobium parasite
STEM- where/ how?
how does it enter?
Chronic infection presents how? (1)
Gold standard diagnostic test?
Management
- Single does of…
- 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
Name the Live attenuated vaccines (5)
- MMR
- BCG
- Oral polio
- Yellow fever
- Oral typhoid
MY
BT
Password- polio
How do you screen for HIV? (2)
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
First line treatment for early Lyme disease is + length of time
- If 1. is CI?
Management of disseminated disease?
14-21 day course of oral doxycycline
If CI (preg) then amoxacillin
ceftriaxone if disseminated disease
Deterioration in patient with hepatitis B - ?
hepatocellular carcinoma
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 =
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
How do you diagnose mycoplasma pneumonia?
serology is diagnostic
E.coli
Gram and cocci or rod?
3 infections it can cause?
strain associated with HUS?
This strain is from?
-ve rod
- Neonate meningitis
- UTI
- Diarrhoeal illnesses
E. coli O157:H7
contaminated ground beef.
Hwow do you surpress MRSA from a carrier once identified? (2)
- nose: mupirocin 2%, tds for 5 days
- skin: chlorhexidine gluconate, od for 5 days. Apply all over but particularly to the axilla, groin and perineum
BV
STEMs (2)
How do you treat BV?
Asymp=
Symptomatic=
(+ Alternative route)
Preg=
Breast feeding = what is CI?
- 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
Management of toxoplasmosis in immuno-competenet
If immuno-suppressed (2)
- no treatment
- Suppressed- Pyrimethamine and sulphadiazine
Otits externa
2 common pathogens cause it, how would lab features differentiate?
- ## Name--
- - ## Name
- Pseudomonas auriginosa
-Gram-negative rod
- non-lactose fermenting
- oxidase positive - Staph Aureus
- Gram ve cocci
Draw out the table for CSF meningits
Bacterial
Viral
TB
Fungal
opening pressure
Appearance (STEM for TB)
Glucose
Protein
White cells
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
At what CD4 count do you commonly get pneumonitits jrvecci?
and receive prophylaxis
What is given for prophylaxis?
< 200
Co-trimoxazole
most common pathogen causing pyelonephritis is
E. coli
Which hepatitis have no vaccine?
Hep C, D, E
A and B do
Aspergilloma
- who does it present in and why?
6 predisposing conditions
CXR STEM (1)
- 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
grey coating is seen surrounding the tonsils, bulky cervical lymphadenopathy (‘bull neck’)think
Management (2)
Diphtheria
- intramuscular penicillin
- diphtheria antitoxin
Genital wart treatment
multiple, non-keratinised warts:
solitary, keratinised warts:
caused by HPV… (2)
multiple, non-keratinised warts: topical podophyllum
solitary, keratinised warts: cryotherapy
HPV 6 & 11.
What are the faecal oral hepatitis?
What are the Blood and sexually transmitted?
Vowels and bowels - AE
B and C for blood and cum
