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EXAM PREP- YR 3 > Infectious diseases- Medicine > Flashcards

Infectious diseases- Medicine Flashcards

1
Q

Malaria- uncomplicated falciparum treatment

A

Artemether with lumefantrine (artemesinin combination therapy)
Or oral quinine plus doxycycline

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2
Q

Malaria- complicated/ severe Falciparum treatment

A

IV artesunate

IV quinine if artesunate not immediately available- continue till pt can complete full oral course of quinine

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3
Q

Malarial prophylaxis

A

Malarone = proguanil + atovaquone

Mefloquine (weekly)

Doxycycline

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4
Q

Malaria endemic areas (WHO)

A

Sub-saharan Africa- majority cases

Others- SE Asia, Eastern Mediterranean, Western Pacific, the Americas

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5
Q

Salmonella- gram pos or neg?

A

Gneg

Aerobic

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6
Q

Typhoid transmission

A

Faecal-oral route

Contaminated food and water

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7
Q

Relative bradycardia + fever…

A

= typhoid fever- pulse rate slow for high fever

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8
Q

Rose spots = ?

A

On chest and abdomen

Typhoid fever

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9
Q

Mx typhoid fever

A

IV ceftriaxone 2g OD
or Azithromycin
or PO Ciprofloxacin (once sensitivities identified)

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10
Q

Define PUO

A

Prolonged fever of > 3 weeks which resists diagnosis after a week in hospital

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11
Q

Typical exam Q patient with Tb

A

Productive cough
Sputum grows acid fast bacilli
Zeihl Neelson staining: red

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12
Q

Latent TB treatment

A

3 months isoniazid and rifampicin

or 6 months isoniazid alone

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13
Q

Active TB treatment

A

Rifampicin and isoniazid for 6 months

Pyrazinamide and ethambutol for first 2 months too

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14
Q

Side effects of Rifampicin

A

General- nausea, thrombocytopoenia, vomiting
Orange urine/ tears
Drug induced hepatitis
Reduces COCP efficacy/ other drugs that use CYP450 - is a potent liver enzyme inducer
(Red-and-orange-pissin)

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15
Q

Side effects of Isoniazid

A

Peripheral neuropathy (reduced by giving pyridoxine)
Colour blindness
Gynaecomastia
Drug induced hepatitis

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16
Q

Why is isoniazid given with pyridoxine?

A

Pyridoxine = B6
to reduce side effect of peripheral neuropathy that isoniazid can cause

(I’m-so-numb-azid)

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17
Q

Side effects of Pyrazinamide

A

Hyperuricaemia - gout
Arthralgia, myalgia
Drug induced hepatitis

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18
Q

Side effects of ethambutol

A

Optic neuropathy/ reduced VA/ colour blindness
-Check VA before + during treatment
(EYE-thambutol)

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19
Q

Causes of erythema nodosum

A 
Throat infections- strep
primary TB
Parasitic infections- amoebiasis
Chlamydia
HSV
Viral hepatitis
HIV

Inflammatory causes- IBD, sarcoidosis, lymphoma, leukaemia

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20
Q

What is ghon complex

A

Ghon focus (small lung lesion due to TB) plus hilar lymph nodes - usually in apical segment of R lower lobe

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21
Q

Where to look when given a TB CXR and you can’t see anything

A

Check the R middle zone

and upper zones -the most aerated portion of the lungs and tubercle bacilli like them

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22
Q

Pt exposed to HIV, no symptoms- do you test?

A

Yes at 4 wks

Then at 12 wks if negative result

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23
Q

What CD4 count = end stage HIV/ AIDs

A

Under 200

Risk of opportunistic infections eg PCP or cyatomegalovirus infection

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24
Q

HIV prophylaxis against PCP?

A

For CD4<200

Co-trimoxazole (septrin)

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25
Q

HIV Vaccinations

A 
Yearly influenza
Pneumococcal once or twice a decade
Hep A and B
Tetanus
Diphtheria
Polio
Avoid live vaccines
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26
Q

Who is offered ART

A

Anti-retroviral therapy

everyone with HIV regardless of viral load or CD4 count

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27
Q

When do people develop HIV antibodies by

A

4-6 weeks normally

definitely by 3 mnths

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28
Q

Screening HIV in pregnancy…

A

NICE recommends screening all pregnant women

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29
Q

Can HIV women breastfeed

A

No

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30
Q

What is meningococcous

A

Neisseria meningitidis
Gneg
diplococci

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31
Q

Most common cause of meningitis

A

Adults- Meningococcus
Pneumococcus (strep pneumoniae)

Neonates to 3mnths- GBS (group B strep)

HI in up to 6yrs is also a possibility

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32
Q

Suspected meningitis + non-blanching rash, seen in GP, what to do?

A

Urgent IM benzylpenicillin (Or IV) prior to transfer to hospital
Suspecting meningococcal meningitis

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33
Q

Why do we give dexamethasone in bacterial meningitis

A

To reduce the deafness and neurological damage

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34
Q

Typical abx treatment for bacterial meningitis

A

Under 3mnths- cefotaxime + amoxicillin

Over 3mnths- ceftriaxone

(cephalosporins) IV

Vancomycin can be added if risk of resistant pneumococcal infection

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35
Q

When is amoxicillin added to cephalosporin treatment for bacterial meningitis

A

Cover for Listeria- for >55 years, or immunocompromised, or <3mnths

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36
Q

If a patient with TB develops a headache and neck stiffness what might you be concerned about and how would you investigate this further?

A

Meningitis
Lumbar puncture= high protein, low glucose, lymphocytosis
MRI scan- leptomeningeal enhancement

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37
Q

Where does spinal cord end

38
Q

Where to do LP

A

L3-4 intervertebral space

39
Q

Results of lumbar puncture for viral infection

A 
Clear appearance
Normal to high protein
Normal glucose
High WCC and lymphocytes
Negative culture
40
Q

Results of lumbar puncture for bacterial infection

A 
Cloudy appearance
High protein
Low glucose
High WCC and neutrophils
Positive bacterial culture
41
Q

Types of TB that can occur

A 
Pulmonary TB
TB meningitis
Pericardial TB
Disseminated/ military TB
Cutaneous TB affecting the skin
42
Q

Antibiotic choice- staph aureus cellulitis

A

Flucloxacillin

43
Q

How do penicillins work

A

Cell wall synthesis inhibitor

44
Q

What are beta lactams

A

Pencillins and cephalosporins

45
Q

Antibiotic choice- strep skin infection

A

Benzylpenicillin or flucloxacillin

46
Q

Penicillin allergy- skin infections

A

Tetracyclines- doxycycline
Carbapenem- meropenem
Cephalosporin- ceftriazone

47
Q

Antibiotic choice- strep pneumoniae CAP

A

Penicillin- amoxicillin
Macrolide- erythromycin, clarithromycin
5 days or 7-10 days depending on severity

48
Q

Antibiotic choice- atypical pneumonia

A

Doxycycline (broad spectrum)

Macrolides- erythromycin, clarithromycin

Fluoroquinolones- ciprofloxacin

49
Q

Mechanism of action of fluroquinolones

A

Inhibits DNA gyrase- targets DNA

50
Q

Mechanism of action of macrolides

A

Erythromycin, clarithromycin, azithromycin

Protein synthesis disruption - inhibit 50s ribosome unit

51
Q

Antibiotic choice- MRSA

A

Resistant to beta lactams due to modification of pencillin-binding protein
Instead use glycopeptides- vancomycin, teicoplanin

Or gentamicin (aminoglycosides)

52
Q

How do aminoglycosides work

A

Target protein synthesis

Inhibit 30s ribosome subunit

53
Q

Abx for E coli gastroenteritis?

A

None
As use of abx increases risk of haemolytic uraemic syndrome (vomiting, bloody diarrhoea, abdominal cramps)- E Coli 0157, shiga toxin

54
Q

A man presents with severe vomiting. Earlier in the day he re-heated rice
Cause?

A

Bacillus cereus
- causes vomiting within 6 hrs
Diarrhoea after 6hrs

55
Q

Gastroenteritis- severe- Antibiotic choice-

A

Ciprofloxacin

Azithromycin

56
Q

Antibiotic choice- Salmonella typhi

A

IV ceftriaxone or azithromycin

57
Q

Antibiotic choice- profuse diarrhoea caused by C difficile

A

Metronidazole PO or vancomycin on second episode

58
Q

Antibiotic choice- visceral infection or peritonitis- eg spleen abscess

A

co-amox or cipro or aminoglycoside eg gentamicine

+ anaerobic cover- metronidazole

If severe infection or penicillin allergy- carbapenem

59
Q

What are carbapenems

A

Cell wall synthesis inhibitors
Very broad spectrum including anaerobes
Safe in penicillin allergies

60
Q

Antibiotic choice- HSV- encephalitis

A

IV acyclovir

61
Q

Antibiotic choice- endocarditis

A

Strep viridans- benzylpenicillin +/- gentamicin

Enterococci- amox +/- gent

62
Q

Antibiotic choice- endocarditis in IVDU

A

Likely staph aureus as a cause- flucloxacillin

Consider bacillus cereus as a cause too

63
Q

Antibiotic choice- sepsis

A

Meropenem (stat dose) (carbapenem=targets cell wall-beta lactam ring)

64
Q

Antibiotic choice- Exacerbations of chronic bronchitis

A

Amoxicillin or tetracycline or clarithromycin

65
Q

Antibiotic choice- Pneumonia possibly caused by atypical pathogens

A

Clarithromycin

66
Q

Antibiotic choice- LUT

A

Trimethoprim or nitrofurantoin

Severe- IV co amoxiclav

67
Q

Antibiotic choice- acute pyelonephritis

A

Broad spec cephalosporin or quinolone

68
Q

Antibiotic choice- throat infections

A

Phenoxymethylpenicillin

If allergic-erythromycin alone

69
Q

Antibiotic choice- chlamydia

A

Doxycline or azithromycin

70
Q

Antibiotic choice- gonorrhoea

A

IM ceftriazone

71
Q

Antibiotic choice- bacterial vaginosis

A

Oral or topical metronidazole or topical clindamycin

72
Q

Aminoglycosides-examples and side effects

A

Nephrotoxicity
Ototoxicity

Gentamicin

73
Q

Tetracyclines- examples and side effects

A

Discolouration of teeth, photosensitivity- tell pt to wear sunscreen
Oesophagitis and swallowing problems

Doxycycline

74
Q

Clindamycin- side effects

A

Common cause of C diff

75
Q

Macrolides- examples and side effects

A 
Erythromycin, clarithromycin, azithromycin
Nausea esp erythromycin
P450 inhibitor
Prolonged QT
Interferes with warfarin/ INR
76
Q

What antibiotic is commonly associated with C difficile infection

A

Clindamycin

77
Q

Vaccinations to avoid in HIV pts

A 
Live attenuated vaccines-
BCG
MMR
oral polio
yellow fever
oral typhoid
Influenza- intranasal
78
Q

Ix of choice for asymptomatic chlamydia pts

A

NAAT

Male- first pass urine

Female- vulvovaginal swab

79
Q

Fever on alternating days, recent travel…

80
Q

Legionella typically colonises where..

A

Air-conditioning systems

Foreign holidays

81
Q

Atypical pneumonia- legionella- diagnosis?

A

Urinary antigen test

82
Q

Antibiotic choice- pregnant lady with symptomatic UTI

A

First line- nitrofurantoin but avoid near term
Second line- amoxicillin or cefalexin
TRIMETHOPRIM IS TERATOGENIC IN 1ST TRIMESTER JUST AVOID IT ALTOGETHER

83
Q

Antibiotic choice- campylobacter

A

Clarithromycin

84
Q

Antibiotic choice- pneumonia secondary to influenza

A

Classically caused by staph aureus

Flucloxacillin

85
Q

Pneumonia in an alcoholic

A

Klebsiella pneumoniae

86
Q

Green offensive chronic ulcer in diabetic pt

A

Pseudomonas

87
Q

Infectious mononucleosis classic triad

A

sore throat, pyrexia and lymphadenopathy

88
Q

Antibiotic choice- animal bite

A

Co-amoxiclav

89
Q

Antibiotic choice- meningitis

A

Benzyl – P – enicillin –> Pre-hospital treatment (e.g. GP)
Cefo – T – axime –> T - reatment
Ci – Pro– floxacin –> Pro - phylaxis

90
Q

Antibiotic choice- chlamydia

A

doxycycline

91
Q

Antibiotic choice- gonorrhoea

A

IM ceftriaxone

EXAM PREP- YR 3 (4 decks)

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