infective diseases Flashcards
1
Q
Immune reconstitution inflammatory syndrome
Most commonly affects?
A
HIV positive pts when starting anti retrovirals
CFS makes any underlying infection much worse
2
Q
Dengue fever
causes
CFs
Ix
Mx
A
dengue = viral disease transmitted by mosquitos
7 days incubation, Aedes aegypti mozzie
Retro-orbital headache, fever, facial flushing, rash, thrombocytopenia in returning traveller
CFs
maculopapular rash blanching, spares palms and soles of feet
retroorbital headache
high fever
lymphadenopathy
haemorrhagic manifestations
Raised ALT
can progress onto viral haemorrhagic fever
Ix= serology, bloods show thrombocytopenia
NS1 antigen test
Tx= symptomatic treatment
no antivirals yet
3
Q
TB vs mycobacterium avian complex treatment
A
TB - RIPE
MAC - RiCE
TB rifampicin, isoniazid, pyrazinamide, ethambutol
MAC; rifampicin, clarithromycin, ethambutol
give clarithromycin proph when CD4 is less than 100 cells/mm³
4
Q
Tetanus
cause
CFs
Ix
Mx
A
tetanospasmin exotoxin released from Clostridium tetani
CFs
lockjaw
fever, headache, fatigue
facial spasms
arched back, extended neck
spasms eg dysphagia
Mx
-supportive
- IM human tetanus immunoglobulin for high-risk wounds
- METRONIDAZOLE
5
Q
suspected lyme disease- management
A
IF NO TARGET erythema migrans– ELISA FIRST
do NOT start doxy if suspicious, but no target lesion
if desseminated disease= give ceftriaxone
6
Q
breast feeding in mothers with hep c
A
OK
allowed
7
Q
is there a vaccine for hep c?
A
NO
8
Q
incubation period hep c
A
6-9 weeks
9
Q
someone wants hep c testing- method for initial diagnosis?
A
anti-HCV antibody test for initial diagnosis
TO CHECK FOR response to treatment:
viral load
10
Q
sexually active young women UTI bacteria?
A
Staphylococcus saprophyticus
11
Q
cryptosporium infection diagnostic test?
and positive result
managemente of cryptosporium diarrhorea for immunosuppressed
A
acid-fast staining of stool sample – cryptosporium cysts turn RED on staining
Ziehl-Neelsen stain
Mx= supportive- even if imm suppressed
12
Q
rickettsiae -
morphology
treatment
A
Gram-negative obligate intracellular parasites
tetracycline treatment
13
Q
Burger with a lyme. Bart has a cat.
A
Borrelia burgdorferi and Bartonella henselae are the causative organisms of Lyme disease and cat-scratch fever.
14
Q
zanamivir (Relenza) treatment– what underlying condition will made side effects worse/.
A
asthma– causes bronchospasm
15
Q
Investigation for HIV Seroconverson illness
what is it
CFs
A
HIV seroconversion= beginning of HIV infection, 1-4 weeks post infection.
p24 antigen test DETECTS
CFs
Glandular fever type illness. Increased symptomatic severity is associated with poorer long term prognosis. It typically occurs 3-12 weeks after infection
sore throat
lymphadenopathy
malaise, myalgia, arthralgia
diarrhoea
maculopapular rash
mouth ulcers
rarely meningoencephalitis
16
Q
gram positive, catalase and coagulase positive cocci.
A
Staphylococcus aureus
17
Q
Gonorrhoea Mx
A
IM ceftriaxone (good gram negative cover0
18
Q
Chlamydia testing diagnostic method
Mx
A
NAAT- vaginal swab
1st line PO doxycycline 7 days
2nd line azithromycin
19
Q
parasite burden— use thick or thin blood films?
A
Parasite burden is evaluated from thick blood films,
20
Q
THIN blood films allow for what?? in malaria
A
speciation— define the species
21
Q
bilateral conjunctival suffusion== ?
A
leptospirosis
22
Q
Anthrax CFs and treatment
A
black eschar that is typically painless; it is treated with ciprofloxacin
regional lymphadenopathy
farmer of livestock
23
Q
rabbit bite + regional lymphadenopathy +pus discharge from lymph
A
tularaemia
24
Q
uncomplicated uti treatment in pregnancy
A
NITROFURANTOIN unless close to term
25
meningeal tuberculosis. treatment
RIPE + prednisolone
26
Non specific (non gonococcal) urethritis treatment
PO Doxy
or
PO azithromycin
27
grey coating on tongue + fever
causative org
gram pos or neg
CFs of this condition
diptheria
Gram positive rod bacterium Corynebacterium diphtheriae
CFs grey skin, bulky cervical lymphadenopathy
heart block, bradycardia
28
Diptheria
CFs
Ix
Tx
-recent visitors to Eastern Europe/Russia/Asia
-sore throat with a 'diphtheric membrane' :grey, pseudomembrane on the posterior pharyngeal wall
-bulky cervical lymphadenopathy
may result in a 'bull neck' appearance
-neuritis e.g. cranial nerves
-heart block
Investigations
culture of throat swab: uses tellurite agar or Loeffler's media
Management
intramuscular penicillin
diphtheria antitoxin
29
Gonorrhoea treatment
Gonorrhoea - intramuscular ceftriaxone
30
salmonella (non-typhoid) Abx
ciprofloxacin
31
Chlamydia Abx
Doxy or azithromycin
32
PID abx
Oral ofloxacin + oral metronidazole
OR
IM ceftriaxone + oral doxycycline + oral metronidazole
33
syphilis Abx and what reaction can happen after first dose
IM Benzathine benzylpenicillin or doxycycline or erythromycin
Jarisch-Herxheimer reaction can occur after initial dose
CFs HoTN, fever, headache. Mx for this is reassure and antipyretic
34
canpylobacter abx
clarithryomycin
35
chikungunya cause
cfs
tx
alphavirus from mosquitoes
CFs
flu symptoms
high fever
sometimes maculopaupular rash
sore joints
Tx= no cure
symptomatic relief
36
Pneumocystis jiroveci penumonia treatment
and staining
co-trimoxazole= mix of trimethoprim and sulfamethoxazole
silver stain
IV pentamidine in severe cases
steroids if hypoxic
37
Pneumonia, peripheral blood smear showing red blood cell agglutination →
Mycoplasma pneumoniae
38
Mycoplasma pneumoniae
CFs
Tx
bil CXR consolidation
dry cough
Ix
serology
agglutination test
can cause GBS or encephalitis
Tx
doxycycline or a macrolide
39
Ix for mono
Heterophile antibodies - infectious mononucleosis
40
infectious mononucleosis causes
CFs
Tx
causes; commonly EBV/HHV4,. less freq=cmv, vhh6
triad of sore throat, pyrexia and lymphadenopathy
rash if take amoxicillin
Ix= heterophile antibody test
and bloods
supportive Mx
symptomatic tx
avoid contat sports 4 weeks due to risk of splenic rupture
41
qwhat is
Aspergilloma
CFs
Ix
tX
COLONISese previous existing lung cavity
Eg previous TB, previous lung ca, CF
presents with haemoptysis, weight loss, cough
may be asymptomatic
Ix= high titre positive aspergillus precipitins
Tx= surgical excision
42
pregnancy - chicken pox exposure before 20 weeks
BEFORE 20WEKS GESTATION if NOT immune/== give VZIG
varicella antibody test asap if unsure
> 20 weeks gestation is not immune to varicella then either VZIG or antivirals (aciclovir or valaciclovir) should be given days 7 to 14 after exposure
43
Hep b vaccine;
> 100
10 - 100
< 10
> 100 - adequate response. booster at 5 years
10 - 100 - one further dose
< 10 - re do all 3 doses
44
Toxoplasmosis infection Mx
if immunocompeteint== no treatment needed
IF EYE INVOLVEMENT OR
if HIV infected/immunosuppressed-- can cause cerebral toxoplasmosis
CT: usually single or multiple ring-enhancing lesions, mass effect may be seen
management: pyrimethamine plus sulphadiazine for at least 6 weeks
45
GRAM POSITIVE COCCI
GRAM NEGATIVE COCCI
gram positive cocci:
staphylococcus, streptococcus, enterococcus
Gram negative cocci
N meningitidis, n gonorrhoea, catarrhalis mox
46
GRAM POSITIVE COCCI
GRAMP NEGATIVE COCCI
gram positive cocci:
staphylococcus, streptococcus, enterococcus
Gram negative cocci
N meningitidis, n gonorrhoea, catarrhalis moxg
47
GRAM POSITIVE COCCI 3
GRAMP NEGATIVE COCCI 3
gram positive cocci:
staphylococcus, streptococcus, enterococcus
Gram negative cocci
N meningitidis, n gonorrhoea, catarrhalis moxG
48
GRAM POSITIVE RODS
GRAM NEGATIVE RODS
GRAM POSITIVE RODS: ABCDL
actinimyces
bacillus
clostridium
diptheria cornybacterium
Listeria
GRAM NEGATIVE RODS
food poisoning: campylobater, shigella, salmonella, e coli
h influenzae
p areginosa
49
Tx times and abx for active TB
RIPE
for 2 months
THne: RI(+P) for 4 months
50
Tx latent tb and how to find out if pt has latent TB
Latent Tb= positive Mantoux test and positive Interferon-gamma release assay
Tx= RI or I only
51
most common cause of viral menigitis
coxsackie/echovirus- enteroviruses
52
most common cause of bacterial meningitis
strep pneumoniae
53
If patient gets syphilis for a second time (after prev infection), what test will show this?
rapid plasma reagin test
all other tests will remain positive for LIFE after the first infection
54
LEPTOSPIROSIS
cause= infected rat urine- sewage worker
urine cultures become positive 2nd week of infection
CFs
-bilateral conjunctivitis
- flu symptoms
- bilateral calf pains and high fevers
longer infection- later stage can cause aseptic meningism, AKI, hepatitis
Tx= high dose benzylpenicillin or doxycycline
55
Negative non-treponemal test + positive treponemal test is consistent with treated or untreated syphilis?
Negative non-treponemal test + positive treponemal test is consistent with successfully treated syphilisq
Following treatment for syphilis: TPHA remains positive, VDRL becomes negative
56
most common bacterial cause strep throat
Strep pyogenes
57
severe parasitaemia treatment
eg fulminant malaria:
if uncomplicated falciparum malaria AND
if SEVERE falciparum malaria
IV artesunate
and exchange transfusion
if uncomplicated falciparum malaria-- give artemether plus lumefantrine
if SEVERE falciparum malaria; give IV artesunate
58
avoid which mediation for malaria prophylaxis in epileptics?
avoid MEFLOQUINE
59
leprosy
CFs
tx
CFs:
hyposthesia over lesions
Thickened cord like structures
patches of hypopigmented skin
Tx: leprosy on dominican republic of congo- DRC
dapsone
Rifampicin
clofazimine
60
treat legionella peumonia-
macrolides
clarythromicib
61
tetanus affects gaba or ach
gaba
62
Praziquantel used to treat ??
schistosomiasis
63
Cysticercosis = tapeworm
treatment?
bendazoles
64
min time before live vaccines can be given back to back
4 weeks
65
which antiviral drug INDUCES P450
and which type of antiviral drug
INHIBITS P450
INDUCER= nevirapine (an NNRTI)
INHIBITOR= proteasome inhibitors, potent inhibitor = ritonavir
66
most dangerous complication of chicken pox in adults
varicella pneumonia== give IV aciclovir
chest can be unremarkable
67
how does Strongyloides stercoralis gain access to the body and treatment of it
CFs
Strongyloides stercoralis gains access to the body by penetrating the skin
=rhabditiform larvae
SO STRONG it can penetrate skin
Ix= ivermctin
CFs
erythematous, serpiginous, urticarial rash on his buttocks and also on the soles of his feet. There is no regional lymphadenopathy.
68
travellers diarrhoea/food poisoning/illness incubation periods
Long bloody diarrhoea- 3-4 weeks or more - amoebiasis
Long watery diarrhoea 1 week - giardiasis
Shorter bloody diarrhoea - Campylobacter
V Short bloody diarrhoea - E. Coli
V short vomiting-- staph aureus
1-6 hrs: Staphylococcus aureus, Bacillus cereus*
12-48 hrs: Salmonella, Escherichia coli
48-72 hrs: Shigella, Campylobacter
> 7 days: Giardiasis, Amoebiasis
69
schistomiasis
cfs
cause
tx
parasitic flat worm infection
70
acute schistosomiasis syndrome also called?
Katayama fever
71
Japanese encephalitis
caused by flavivirus
viral encephalitis
cfs
seizures headache confusion
fever
parkinsonian features (indicate basal ganglia ivolvement)
Tx= supportive
vaccine exists
72
who to offer HPV vaccine to apart from teenagers
men under 45yo who have sex w men
73
genital ulcers
Painless=?
granuloma inguinale:
granuloma inguinale: Klebsiella granulomatis*
painless= syphilis and lymphogranuloma venereum (chalmydia, tenesmus, proctitis)
painful- chancroid
74
genital ulcers
LGV - Chlamydia trachomatis.
Granuloma inguinale - Klebsiella granulomatis.
Syphilis - Treponema pallidum.
Chancre - Treponema Pallidum.
Chancroid - Haemophilus ducreyii.
75
reheated rice poisoining organism
bacillus cereus
76
BV fishy smell causative organism
Gardnerella vaginalis
gram positive coccobacilli
Tx= po metronidazole
77
Tetanus treatment
if pt has had all 5 doses within last 10 years= no further action needed
If had all 5 doses over 10 years ago:
-Tetanus prone wound= give booster vaccine
- High risk wound= give vaccine booster AND tetanus ig
If vaccine status unknown:
- ALL tetanus prone = give vaccine booster
- if High risk wound= give booster vaccine AND tetanus ig
78
what is Jarisch-Herxheimer reaction
reaction in in syphilis pt post intial dose of ABx
HoTN, fever, headache
Tx= reassure and antipyretic
79
aciclovir MOA
DNA polymerase inhibitor
80
kaposi sarcoma causative virus
HHV 8
81
contraindicated vaccines in HIV positive adults
and which vaccines can be given in HIV if cd4 >200
cholera
influenza nasal
polio oral
BCG
Vaccines that can be used if CD4 > 200
MMR
varicella
yellowfever
82
what is leishmaniasis
Leishmaniasis is caused by the intracellular protozoa Leishmania, which are spread by the bites of sandflies. Cutaneous, mucocutaneous leishmaniasis and visceral forms are seen
Looks like an ulcer
CFs
grey skin
hepatospleomegaly
fever sweats rigors
poor appetite
pancytopenia secondary to hypersplenism
Dx= punch biopsy
83
meningococcal meningitis mx
close contact mx
do not delay for LP
at GP: give IM benzylpenicillin
IV acces <50 give cefotaxime
>50 give cefotaxime + amoxicillin
close contacts - po ciprofloxacin or rifampicin
84
lymph node biopsy with warthin starry staining ==?
bartonella heneslae- cat scratch disease
85
which medication is used to
treat immunocompromised patients with cryptosporidiosis
Nitazoxanide
86
neuro complication of cryptococcus
cryptococcus treatment =
neuro=
india ink test positive
87
Lymphogranuloma venereum ( caused by which STi
chlamydia
88
flu like illness → brief remission→ followed by jaundice and haematemesis
yellow fever
council man bodies
flu symptoms
can have brief remission before jaundice, haemetemesis
89
acute epiglottitis causative organism
h influenzae
90
Clostridium botulinum
What does this cause
CFs
Tx
causes botulism
CFs
apyrexic
flacid, descending paralysis
high risk in food poisoning and IVDUs
can affect bulbar mms
Tx= botulism antitoxin
91
What immune response component is the first line of action against aspergillosis? (different to aspergilloma)
macrophages
92
Syphilis, Lymphogranuloma venereum (LGV) and donovanosis (granuloma inguinal) painfull or pain less ulcers
these all cause PAINLESS genital ulcers
93
Non specific (non gonococcal) urethritis management
oral doxy one week
94
enteric fever
transmission moa
cause
cfs
tx
enteric fever= typhoid
transmitted via faeco oral route
95
rocky mountain spotted fever causative org
rickettsia ricketssi
96
how often to give dex during bacterial meningitis tx
6 hourly
97
which organism most associated w reactivation or Herpes simplex
strep pneumonia
98
most common organism in animal bites =?
Pasteurella multocida.
Tx= co amox
99
what is an exotoxin and are they gram positive or negative, and with which exceptions
exotoxins are secreted by bacteria
mostly gram POSITIVE
except cholera and e coli
100
what are enterotoxins
act on GI
to cause d and v
101
most common cause of visceral larva migrans?
toxicara canis
102
live vaccines
LIVE VACCINES:
I MoP YR, BoT- influenza, MMR, oral Polio, Yellow fever, oral Rotavirus, BCG, oral Typhoid
103
erythromycin MOA
inhibit 50s
104
HIV testing: when
can test from 4 weeks post exposure
TO TEST:
P24 = combined antigen and antibody test
105
brucellosis
Middle East and in farmers, vets and abattoir workers.
sheep cattle pigs
Features
non-specific: fever, malaise
hepatosplenomegaly
sacroiliitis: spinal tenderness may be seen
complications: osteomyelitis, infective endocarditis, meningoencephalitis, orchitis
leukopenia often seen
Diagnosis
Rose Bengal plate test can be used for screening
!!!!!Brucella serology is the best test for diagnosis
blood and bone marrow cultures may be suitable in certain patients, but these tests are often negative
Tx= doxy and streptomycin
106
most common org cause of central line infections
staph epidermis
107
atypical lymphocytes seen ==?
infective mono
108
listeria treatment
amoxicillin
109
Brain CT problems in HIV
Toxoplasmosis
Lymphoma
Progressive multifocal leukoencephalopathy (PML)
Lymphoma: Single lesion. Solid enhancement
Toxoplasmosis : Multiple lesion, Ring, or nodular enhancement
PML: Single or multiple lesions. No enhancement no mass effect
110
pregnancy and HIV
all pregnant women should be offered antiretroviral therapy regardless of whether they were taking it previously
vaginal delivery is recommended if viral load is less than 50 copies/ml at 36 weeks, otherwise caesarian section is recommended
a zidovudine infusion should be started 4 hours before beginning the caesarean section
Neonatal antiretroviral therapy
zidovudine is usually administered orally to the neonate if maternal viral load is <50 copies/ml. Otherwise triple ART should be used. Therapy should be continued for 4-6 weeks.
DO NOT BREAST FEED
111
egg allergy cannot have ?vaccine
yellow fever and influenza
egg yolk ==yellow
112
mumps meningitis CSF glucose :
low =- approx 2
other viral meningitis forms= eg adenovirus. enterovirus= glucose not that low
113
urine dip nitrate positive or negative
gram positive
gram negative
gram positive= will test nitrate NEGATIVE
gram negative = nitrate positive
= opposite
114
most common cause of viral meningitis = ?
enteroviruses eg coxsackie
115
which hepatitis is most common in pregnant women
hep E
116
rabies vaccine and management if bitten
if bitten in UK- no risk
BITTEN IN high risk country
prev immunised= 2 booster vaccine doses
not immunised= full course of vaccine
PLUS prophylactic abx
117
gram+ve bacterium, catalase +ve, coagulase +ve organism
staphy aureus
Streptococcus viridans and Streptococcus pyogenes are both catalase negative.
Staphylococcus epidermidis is catalase positive but coagulase negative.
118
amantadine MOA
amanda does not want to take off her coat
inhibits uncoating (M2 protein) of virus in cell. Also releases dopamine from nerve endings
119
pneumonia +erythema multiforme=?
mycoplasma
120
causative organism in Q fever
Coxiella burnetti
121
hyposplenism/ spleen removal need for immunisations
pneumococcal, Hib and meningococcus type C
annual flu jab and
life long Penicillin V cover
2 weeks prior or after splenectomy
122
Alongside Streptococci spp. and Staphylococcus aureus, which of the following organisms is most likely to be isolated in HUMAN BITE
Eikenella
123
wet hay smell when sweats, cheese
brucella melentenis
124
Amantadine MOA
inhibits uncoating (M2 protein) of virus in cell. Also releases dopamine from nerve endings
125
Lemierre's Syndrome= ?
infectious thrombophlebitis of IJV
occurs secondary to a bacterial sore throat caused by Fusobacterium necrophorum leading to a peritonsillar abscess.
RISK of septic pulmonary emboli
126
EBV is a type of ??? virus
EBV is a type of herpes virus
127
A 42-year-old man from Southern India presents with chronic swelling of both lower legs, they are brawny and indurated with marked skin trophic changes. Which one of the following organisms is the most likely origin of this disease process?
Wuchereria bancrofti
BANCROFT = posh= brawny and skin trophic changes
128
first line treatment in hydatid disease?
albendazole
129
what conditions (4) can cause False positive VDRL/RPR:
'Some Times Mistakes Happen' (SLE, TB, malaria, HIV)
130
what abx to give for botulism and tetanus
BBBenPen for BBBBBotulism
Metro for Tetro
131
severe malaria if parasitaemia
Parasitaemia > 2% is a feature of severe malaria
132
management of latent TB
3 months R +I+P
OR
6months of
I +P
133
predom bacterialcidal abx
CORe - ChlORamphenicol
Medical - Macro
TRAinee - TeTRAcycline
to
SPecialty - SulPhonamide
TRaInee - TRImethoprim
134
which abx promotes acquisition of MSRA
ciprofloxacin
135
abx for cholera
doxy or cipro
136
common cause campylobacter
chicken
137
which conditions can be affected by Jax heimer reaction
syphilis
HIV
lyme disease
138
post HIV exposure proph
1 month 3 anti retrovirals
139
marked eosinophilia of lamina propria= ?
eosinophilic gastroenteritis
140
threadworms causative organism
enterobius vermicularis
141
what to check when checking if hep b vaccine works
Anti-HBs
142
most common cause of visceral larva migrans
toxocara canis
143
yersinia =?
treatment
bacterial cause of diarrhoea
sensitive to quinolones, tetracyclines, co trimoxaxole
eg gentamicin ( if no renal problems), ofloxacin, ciprofloxacin
144
bacterial vaginosis morphology
Gram positive coccobacilli
145
Abx for severe diabetic foot infection/ ulcer - even if shows some fungal /anaerobic growth
IV CO AMOX -- broad
