Infectious diseases II Flashcards
What are the typical pathogens that cause meningitis in the following:
a) neonates,
b) children + teenagers,
c) adults + elderly?
a) Group B strep (long labour, infection in prev. pregnancy), E. Coli (late neonatal infection), Listeria monocytogenes
b) Neisseria meningitides (gram - ve diplococci), H. influenzae (if unvaccinated)
c) Strep. pneumoniae (gram +ve cocci), Listeria monocytogenes (cheese/unpasteurised milk, alcoholics)
Meningitis CSF findings if the following are the cause:
a) bacteria
b) virus
c) TB
a) turbid appearance, high neutrophils, high protein, low glucose, +ve gram stain
b) clear/cloudy appearance, high lymphocytes, high protein, normal glucose, N/A gram stain
c) clear/cloudy appearance, high lymphocytes, high proteins, low glucose, NA gram stain
Causes and RFs of infective endocarditis
Bacterial causes: Streptococci viridans - congenital heart valves Streptococci bovis - GI malignancy Staphylococci aureus Staphylococci epidermis - IVDU Enterococci HACEK
RFs: Abnormal valves Prosthetic heart valves IVDU Turbulent flow; PDA, VSD Recent dental work
Signs + sx of infective endocarditis
Clubbing, pyrexia, tachycardia, signs of anaemia, vasculitic lesions, splenomegaly, new murmur (mitral>aortic>tricuspid>pulmonary)
Fever w/ sweats/chills/rigors, malaise, arthralgia, myalgia, confusion
Mnemonic for infective endocarditis signs
F ever R oth spots O sler nodes M urmur J aneway lesions A naemia N ail-bed haemorrhage E mboli
Ix and mx of infective endocarditis
Ix:
- bloods: FBC (high WCC, normocytic anaemia), ESR + CRP, U&Es, RF +ve
- 3 blood cultures, 1hr apart within 24 hours
- urgent ECHO
- Dukes classification
- broad spectrum Abx until MCS
Mx with Abx for 4-6 weeks:
if native valves
- S. aureus => flucloxacillin
- S. viridans => benzylpenicillin + gentamicin
if prosthetic valves
- Staphylococci => flucloxacillin/vancomycin + rifampicin + gentamicin
Complications of infective endocarditis
Congestive heart failure Valve incompetence Aneurysm formation Systemic embolism Renal failure Glomerulonephritis
Infective endocarditis buzzwords
Prosthetic valve Dental procedure New onset murmur Vegetation on ECHO Right heart-indwelling catheter
Which bacteria has caused the gastroenteritis?
a) Rice water diarrhoea
b) Last thing ate was leafy veg
c) Recent hx of Abx use
d) Low sanitation
e) Uncooked poultry
f) Uncooked eggs
g) Reheated rice
h) Children have recently had gastroenteritis
a) Vibrio cholera
b) E. coli
c) C. dif
d) Entamoeba histolytica
e) Campylobacter
f) Salmonella
g) Bacillus aureus
g) Shigella
Organisms that cause diarrhoea vs dysentery
Diarrhoea
- Campylobacter/C. dif
- Staph. aureus
- Vibrio cholera
- E coli
- Bacillus aureus
- Salmonella
Dysentry (w/ blood)
- C amplyobacter/C dif.
- H aemorrhagic E. coli
- E ntamoeba histolytica
- S higella
- S almonella
Hep A&E summary
A&E => fAEco-oral hepatitis
A: acute (travel hx, shellfish) and asymptomatic (usually)
E: enteric, epidermics (water), expectant mothers, e-immunocompromised
Mx => supportive + avoid alcohol
Hep B(D) + C summary
B: baby-making, blood, birthing (perinatal)
D: co-infection
C: chronic, RF for hepatocellular carcinoma
Hepatitis triad of sx
I. fever
II. jaundice
III. raised ALT + AST
Malaria summary card
Endemic in tropics, infection w/ protozoan Plasmodium (most common is P. falciparum)
= headache, weakness, myalgia/arthralgia, anorexia, fever (severe cold/rigors followed by severe sweating)
= splenomegaly, anaemia, pyrexia
Ix
= Giemsa-stained thick and thin blood smears
= thick to detect which parasite present
= thin to identify species
= FBC, clotting profile, U&Es, FTs, glucose, urinalysis, ABG
A baby girl born 1 day ago born after a long vaginal labour, becomes drowsy. On examination, T: 38.9, HR: 170bpm, RR: 30. Which is the most likely causative agent?
A Neisseria meningitis B Streptococcus pneumonia C Listeria monocytogenes D Group B streptococcus E E. Coli
D Group B streptococcus
A 21-year-old wild medical student presents with neck stiffness and photophobia. He has a non-blanching rash. Which of the following is the most likely finding from his LP?
A Turbid colour, Increased polymorphs, normal monocytes, low glucose, high protein
B Clear colour, normal polymorphs, high lymphocytes, normal glucose, high protein
C Turbid colour, normal polymorphs, high lymphocytes, low glucose, normal protein
D Cloudy colour, normal polymorphs, high lymphocytes, low glucose, high protein
E Clear colour, high polymorphs, normal lymphocytes, low glucose, high protein
A Turbid colour, Increased polymorphs, normal monocytes, low glucose, high protein
A 72-year-old patient with a new onset murmur, fever and clubbing presents with blood in his stools and weight loss over the past 5 months. Which is the most likely causative agent?
A Staph aureus B Staph epidermis C Streptococcus viridian D Streptococcus bovis E Enterococci
D Streptococcus bovis
A 15-year-old boy with DiGeorge syndrome had a dental tooth extraction 2 weeks ago, visits his GP who on auscultation finds a new murmur on the left sternal edge. Basic observations: BP 110/80, HR: 95, Temperature: 38.5, SaO2 98% on air. What is the most likely causative agent?
A Staph aureus B Staph epidermis C Streptococcus viridian D Streptococcus bovis E Enterococci
C Streptococcus viridian
A 24 year old medical student comes back from their holiday and presents to A&E with profuse diarrhoea of rice water appearance. There is no blood. What is the most likely causative agent?
A Entamoeba histolytica B Staph aureus C Bacillus cereus D E. Coli E Vibrio cholera
E Vibrio cholera
A 40 year old woman presents to A&E with bloody, foul smelling diarrhoea. She went to a barbeque yesterday where she suspects she ate undercooked chicken. She has a fever and severe abdominal pain. What is the most likely causative agent?
A Campylobacter B Shigella C Bacillus cereus D E. coli E Salmonella
A Campylobacter
A 67 year old male has been in hospital for the past two weeks for severe pneumonia. He develops bloody diarrhoea, colitis and reduced urine output. He has raised CRP, WCC and low albumin. What is the most likely causative organism?
A Campylobacter B C. Difficile C Bacillus cereus D E. Coli E Vibrio cholera
B C. Difficile
A 37-year-old bride-to-be returned from Jamaica 3 days ago, where she partied and explored the local cuisine with her best friends. She presents to her GP complaining of being jaundiced with right upper quadrant pain and fever. What is the most likely cause of her symptoms?
A Alcoholic hepatitis B Gall stones C Cholecystitis D Hepatitis A E Hepatitis C
D Hepatitis A
A 64-year-old male with thalassaemia is investigated under the two-week wait for jaundice, hepatomegaly and weight loss. His blood tests show a raised αFP. Which chronic infection is he most likely to have?
A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D E. Hepatitis E
C. Hepatitis C
A 27-year-old promiscuous man returns from a trip to Thailand with a right upper quadrant pain, fever and raised ALP and AST. Which is the most likely causative agent?
A Hepatitis A B Hepatitis B C Hepatitis C D Hepatitis D E Hepatitis E
B Hepatitis B
A 35-year-old woman presenting to her GP with increased urinary frequency and lower back pain. On examination her BP is 130/90, HR: 83bpm, RR: 17bpm and T: 38.3. Which is the most likely finding on her urine dip stick and MC&S?
A Positive nitrites and Gram-positive coccus
B Positive nitrites and Gram-negative bacilli
C Positive glucose, negative nitrites and negative culture.
D Positive glucose, positive nitrites and negative culture
E Positive nitrites and Gram-negative coccus
B Positive nitrites and Gram-negative bacilli
which is the most likely causative agent of a UTI?
A Proteus B Klebsiella C Staph aureus D Enterococci E E. Coli
E E. Coli
A 45-year old man presented to his GP with cyclical fevers. He returned from Ethiopia 10 days ago. What is the most likely causative agent?
A Salmonella typhi B Yersinia pestis C Leptospirosis D Plasmodium falciparum E Coxiella burnetii
D Plasmodium falciparum
A 22 year old university student is seen in the GP with a fever, headache, neck stiffness and photophobia. Which is the most likely causative organism in this patient?
A Bacterial meningitis due to Haemophilus influenzae
B Bacterial meningitis due to Neisseria meningitides
C Bacterial meningitis due to Streptococcus pneumoniae
D Fungal meningitis
B Bacterial meningitis due to Neisseria meningitides
A 22 year old university student is seen in the A&E with a fever, headache, neck stiffness and photophobia. A lumbar puncture was performed. The appearance of the fluid is clear, there are raised proteins and normal glucose. Lymphocyte count is raised. What is the most likely cause of this?
A Bacterial meningitis B Drug induced meningitis C Fungal meningitis D TB meningitis E Viral meningitis
E Viral meningitis
40 year old woman returns from holiday in Vietnam. She started getting diarrhoea after eating some local food on her last day in Vietnam. She presents with fever, nausea and is sore all over. The white of her eyes are yellow.
What is the most likely causative organism?
A Hepatitis A
B Hepatitis B
C Hepatitis C
D Hepatitis D
E Hepatitis E
A Hepatitis A
A 29 yo male comes to the GP with fever, fatigue, joint pain and urticaria-like skin rash. He had unprotected anal sex a month ago. He comes back a week later for a blood test, which shows raised ALT and AST. He now complains of feeling sick, RUQ pain and looks a bit yellow.
What is the most likely causative organism?
A Hepatitis A
B Hepatitis B
C Hepatitis C
D Hepatitis D
E Hepatitis E
B Hepatitis B
Which hepatitis virus requires another virus to be present for it to successfully infect?
A Hepatitis A B Hepatitis B C Hepatitis C D Hepatitis D E Hepatitis E
D Hepatitis D
