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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

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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

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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

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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

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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

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6
Q

breast feeding in mothers with hep c

A

OK
allowed

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7
Q

is there a vaccine for hep c?

A

NO

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8
Q

incubation period hep c

A

6-9 weeks

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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

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10
Q

sexually active young women UTI bacteria?

A

Staphylococcus saprophyticus

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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

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12
Q

rickettsiae -
morphology

treatment

A

Gram-negative obligate intracellular parasites

tetracycline treatment

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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.

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14
Q

zanamivir (Relenza) treatment– what underlying condition will made side effects worse/.

A

asthma– causes bronchospasm

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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

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16
Q

gram positive, catalase and coagulase positive cocci.

A

Staphylococcus aureus

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17
Q

Gonorrhoea Mx

A

IM ceftriaxone (good gram negative cover0

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18
Q

Chlamydia testing diagnostic method

Mx

A

NAAT- vaginal swab

1st line PO doxycycline 7 days
2nd line azithromycin

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19
Q

parasite burden— use thick or thin blood films?

A

Parasite burden is evaluated from thick blood films,

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20
Q

THIN blood films allow for what?? in malaria

A

speciation— define the species

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21
Q

bilateral conjunctival suffusion== ?

A

leptospirosis

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22
Q

Anthrax CFs and treatment

A

black eschar that is typically painless; it is treated with ciprofloxacin
regional lymphadenopathy

farmer of livestock

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23
Q

rabbit bite + regional lymphadenopathy +pus discharge from lymph

A

tularaemia

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24
Q

uncomplicated uti treatment in pregnancy

A

NITROFURANTOIN unless close to term

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25
Q

meningeal tuberculosis. treatment

A

RIPE + prednisolone

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26
Q

Non specific (non gonococcal) urethritis treatment

A

PO Doxy
or
PO azithromycin

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27
Q

grey coating on tongue + fever

causative org
gram pos or neg

CFs of this condition

A

diptheria
Gram positive rod bacterium Corynebacterium diphtheriae

CFs grey skin, bulky cervical lymphadenopathy
heart block, bradycardia

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28
Q

Diptheria
CFs
Ix
Tx

A

-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

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29
Q

Gonorrhoea treatment

A

Gonorrhoea - intramuscular ceftriaxone

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30
Q

salmonella (non-typhoid) Abx

A

ciprofloxacin

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31
Q

Chlamydia Abx

A

Doxy or azithromycin

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32
Q

PID abx

A

Oral ofloxacin + oral metronidazole
OR

IM ceftriaxone + oral doxycycline + oral metronidazole

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33
Q

syphilis Abx and what reaction can happen after first dose

A

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

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34
Q

canpylobacter abx

A

clarithryomycin

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35
Q

chikungunya cause
cfs
tx

A

alphavirus from mosquitoes

CFs
flu symptoms
high fever
sometimes maculopaupular rash
sore joints

Tx= no cure
symptomatic relief

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36
Q

Pneumocystis jiroveci penumonia treatment

and staining

A

co-trimoxazole= mix of trimethoprim and sulfamethoxazole

silver stain

IV pentamidine in severe cases
steroids if hypoxic

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37
Q

Pneumonia, peripheral blood smear showing red blood cell agglutination →

A

Mycoplasma pneumoniae

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38
Q

Mycoplasma pneumoniae
CFs
Tx

A

bil CXR consolidation
dry cough

Ix
serology
agglutination test

can cause GBS or encephalitis

Tx
doxycycline or a macrolide

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39
Q

Ix for mono

A

Heterophile antibodies - infectious mononucleosis

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40
Q

infectious mononucleosis causes
CFs
Tx

A

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

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41
Q

qwhat is
Aspergilloma

CFs

Ix
tX

A

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

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42
Q

pregnancy - chicken pox exposure before 20 weeks

A

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

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43
Q

Hep b vaccine;

> 100
10 - 100
< 10

A

> 100 - adequate response. booster at 5 years

10 - 100 - one further dose

< 10 - re do all 3 doses

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44
Q

Toxoplasmosis infection Mx

A

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

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45
Q

GRAM POSITIVE COCCI

GRAM NEGATIVE COCCI

A

gram positive cocci:
staphylococcus, streptococcus, enterococcus

Gram negative cocci
N meningitidis, n gonorrhoea, catarrhalis mox

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46
Q

GRAM POSITIVE COCCI

GRAMP NEGATIVE COCCI

A

gram positive cocci:
staphylococcus, streptococcus, enterococcus

Gram negative cocci
N meningitidis, n gonorrhoea, catarrhalis moxg

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47
Q

GRAM POSITIVE COCCI 3

GRAMP NEGATIVE COCCI 3

A

gram positive cocci:
staphylococcus, streptococcus, enterococcus

Gram negative cocci
N meningitidis, n gonorrhoea, catarrhalis moxG

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48
Q

GRAM POSITIVE RODS

GRAM NEGATIVE RODS

A

GRAM POSITIVE RODS: ABCDL
actinimyces
bacillus
clostridium
diptheria cornybacterium
Listeria

GRAM NEGATIVE RODS
food poisoning: campylobater, shigella, salmonella, e coli
h influenzae
p areginosa

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49
Q

Tx times and abx for active TB

A

RIPE
for 2 months

THne: RI(+P) for 4 months

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50
Q

Tx latent tb and how to find out if pt has latent TB

A

Latent Tb= positive Mantoux test and positive Interferon-gamma release assay

Tx= RI or I only

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51
Q

most common cause of viral menigitis

A

coxsackie/echovirus- enteroviruses

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52
Q

most common cause of bacterial meningitis

A

strep pneumoniae

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53
Q

If patient gets syphilis for a second time (after prev infection), what test will show this?

A

rapid plasma reagin test

all other tests will remain positive for LIFE after the first infection

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54
Q

LEPTOSPIROSIS

A

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

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55
Q

Negative non-treponemal test + positive treponemal test is consistent with treated or untreated syphilis?

A

Negative non-treponemal test + positive treponemal test is consistent with successfully treated syphilisq

Following treatment for syphilis: TPHA remains positive, VDRL becomes negative

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56
Q

most common bacterial cause strep throat

A

Strep pyogenes

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57
Q

severe parasitaemia treatment

eg fulminant malaria:
if uncomplicated falciparum malaria AND

if SEVERE falciparum malaria

A

IV artesunate
and exchange transfusion

if uncomplicated falciparum malaria– give artemether plus lumefantrine

if SEVERE falciparum malaria; give IV artesunate

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58
Q

avoid which mediation for malaria prophylaxis in epileptics?

A

avoid MEFLOQUINE

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59
Q

leprosy
CFs
tx

A

CFs:
hyposthesia over lesions
Thickened cord like structures
patches of hypopigmented skin

Tx: leprosy on dominican republic of congo- DRC

dapsone
Rifampicin
clofazimine

60
Q

treat legionella peumonia-

A

macrolides
clarythromicib

61
Q

tetanus affects gaba or ach

A

gaba

62
Q

Praziquantel used to treat ??

A

schistosomiasis

63
Q

Cysticercosis = tapeworm

treatment?

A

bendazoles

64
Q

min time before live vaccines can be given back to back

A

4 weeks

65
Q

which antiviral drug INDUCES P450
and which type of antiviral drug
INHIBITS P450

A

INDUCER= nevirapine (an NNRTI)

INHIBITOR= proteasome inhibitors, potent inhibitor = ritonavir

66
Q

most dangerous complication of chicken pox in adults

A

varicella pneumonia== give IV aciclovir

chest can be unremarkable

67
Q

how does Strongyloides stercoralis gain access to the body and treatment of it

CFs

A

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
Q

travellers diarrhoea/food poisoning/illness incubation periods

A

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
Q

schistomiasis
cfs
cause
tx

A

parasitic flat worm infection

70
Q

acute schistosomiasis syndrome also called?

A

Katayama fever

71
Q

Japanese encephalitis

A

caused by flavivirus
viral encephalitis
cfs
seizures headache confusion
fever
parkinsonian features (indicate basal ganglia ivolvement)

Tx= supportive
vaccine exists

72
Q

who to offer HPV vaccine to apart from teenagers

A

men under 45yo who have sex w men

73
Q

genital ulcers

Painless=?
granuloma inguinale:

A

granuloma inguinale: Klebsiella granulomatis*

painless= syphilis and lymphogranuloma venereum (chalmydia, tenesmus, proctitis)

painful- chancroid

74
Q

genital ulcers

A

LGV - Chlamydia trachomatis.
Granuloma inguinale - Klebsiella granulomatis.
Syphilis - Treponema pallidum.
Chancre - Treponema Pallidum.
Chancroid - Haemophilus ducreyii.

75
Q

reheated rice poisoining organism

A

bacillus cereus

76
Q

BV fishy smell causative organism

A

Gardnerella vaginalis

gram positive coccobacilli
Tx= po metronidazole

77
Q

Tetanus treatment

A

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
Q

what is Jarisch-Herxheimer reaction

A

reaction in in syphilis pt post intial dose of ABx
HoTN, fever, headache

Tx= reassure and antipyretic

79
Q

aciclovir MOA

A

DNA polymerase inhibitor

80
Q

kaposi sarcoma causative virus

A

HHV 8

81
Q

contraindicated vaccines in HIV positive adults

and which vaccines can be given in HIV if cd4 >200

A

cholera
influenza nasal
polio oral
BCG

Vaccines that can be used if CD4 > 200
MMR
varicella
yellowfever

82
Q

what is leishmaniasis

A

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
Q

meningococcal meningitis mx

close contact mx

A

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
Q

lymph node biopsy with warthin starry staining ==?

A

bartonella heneslae- cat scratch disease

85
Q

which medication is used to
treat immunocompromised patients with cryptosporidiosis

A

Nitazoxanide

86
Q

neuro complication of cryptococcus

A

cryptococcus treatment =
neuro=
india ink test positive

87
Q

Lymphogranuloma venereum ( caused by which STi

A

chlamydia

88
Q

flu like illness → brief remission→ followed by jaundice and haematemesis

A

yellow fever
council man bodies

flu symptoms

can have brief remission before jaundice, haemetemesis

89
Q

acute epiglottitis causative organism

A

h influenzae

90
Q

Clostridium botulinum
What does this cause
CFs
Tx

A

causes botulism

CFs
apyrexic
flacid, descending paralysis

high risk in food poisoning and IVDUs
can affect bulbar mms

Tx= botulism antitoxin

91
Q

What immune response component is the first line of action against aspergillosis? (different to aspergilloma)

A

macrophages

92
Q

Syphilis, Lymphogranuloma venereum (LGV) and donovanosis (granuloma inguinal) painfull or pain less ulcers

A

these all cause PAINLESS genital ulcers

93
Q

Non specific (non gonococcal) urethritis management

A

oral doxy one week

94
Q

enteric fever
transmission moa
cause
cfs
tx

A

enteric fever= typhoid
transmitted via faeco oral route

95
Q

rocky mountain spotted fever causative org

A

rickettsia ricketssi

96
Q

how often to give dex during bacterial meningitis tx

A

6 hourly

97
Q

which organism most associated w reactivation or Herpes simplex

A

strep pneumonia

98
Q

most common organism in animal bites =?

A

Pasteurella multocida.
Tx= co amox

99
Q

what is an exotoxin and are they gram positive or negative, and with which exceptions

A

exotoxins are secreted by bacteria

mostly gram POSITIVE
except cholera and e coli

100
Q

what are enterotoxins

A

act on GI
to cause d and v

101
Q

most common cause of visceral larva migrans?

A

toxicara canis

102
Q

live vaccines

A

LIVE VACCINES:

I MoP YR, BoT- influenza, MMR, oral Polio, Yellow fever, oral Rotavirus, BCG, oral Typhoid

103
Q

erythromycin MOA

A

inhibit 50s

104
Q

HIV testing: when

A

can test from 4 weeks post exposure
TO TEST:
P24 = combined antigen and antibody test

105
Q

brucellosis

A

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
Q

most common org cause of central line infections

A

staph epidermis

107
Q

atypical lymphocytes seen ==?

A

infective mono

108
Q

listeria treatment

A

amoxicillin

109
Q

Brain CT problems in HIV

Toxoplasmosis

Lymphoma

Progressive multifocal leukoencephalopathy (PML)

A

Lymphoma: Single lesion. Solid enhancement
Toxoplasmosis : Multiple lesion, Ring, or nodular enhancement
PML: Single or multiple lesions. No enhancement no mass effect

110
Q

pregnancy and HIV

A

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
Q

egg allergy cannot have ?vaccine

A

yellow fever and influenza

egg yolk ==yellow

112
Q

mumps meningitis CSF glucose :

A

low =- approx 2

other viral meningitis forms= eg adenovirus. enterovirus= glucose not that low

113
Q

urine dip nitrate positive or negative

gram positive

gram negative

A

gram positive= will test nitrate NEGATIVE

gram negative = nitrate positive

= opposite

114
Q

most common cause of viral meningitis = ?

A

enteroviruses eg coxsackie

115
Q

which hepatitis is most common in pregnant women

A

hep E

116
Q

rabies vaccine and management if bitten

A

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
Q

gram+ve bacterium, catalase +ve, coagulase +ve organism

A

staphy aureus

Streptococcus viridans and Streptococcus pyogenes are both catalase negative.

Staphylococcus epidermidis is catalase positive but coagulase negative.

118
Q

amantadine MOA

A

amanda does not want to take off her coat

inhibits uncoating (M2 protein) of virus in cell. Also releases dopamine from nerve endings

119
Q

pneumonia +erythema multiforme=?

A

mycoplasma

120
Q

causative organism in Q fever

A

Coxiella burnetti

121
Q

hyposplenism/ spleen removal need for immunisations

A

pneumococcal, Hib and meningococcus type C
annual flu jab and
life long Penicillin V cover

2 weeks prior or after splenectomy

122
Q

Alongside Streptococci spp. and Staphylococcus aureus, which of the following organisms is most likely to be isolated in HUMAN BITE

A

Eikenella

123
Q

wet hay smell when sweats, cheese

A

brucella melentenis

124
Q

Amantadine MOA

A

inhibits uncoating (M2 protein) of virus in cell. Also releases dopamine from nerve endings

125
Q

Lemierre’s Syndrome= ?

A

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
Q

EBV is a type of ??? virus

A

EBV is a type of herpes virus

127
Q

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?

A

Wuchereria bancrofti

BANCROFT = posh= brawny and skin trophic changes

128
Q

first line treatment in hydatid disease?

A

albendazole

129
Q

what conditions (4) can cause False positive VDRL/RPR:

A

‘Some Times Mistakes Happen’ (SLE, TB, malaria, HIV)

130
Q

what abx to give for botulism and tetanus

A

BBBenPen for BBBBBotulism
Metro for Tetro

131
Q

severe malaria if parasitaemia <????%

A

Parasitaemia > 2% is a feature of severe malaria

132
Q

management of latent TB

A

3 months R +I+P

OR
6months of
I +P

133
Q

predom bacterialcidal abx

A

CORe - ChlORamphenicol
Medical - Macro
TRAinee - TeTRAcycline
to
SPecialty - SulPhonamide
TRaInee - TRImethoprim

134
Q

which abx promotes acquisition of MSRA

A

ciprofloxacin

135
Q

abx for cholera

A

doxy or cipro

136
Q

common cause campylobacter

A

chicken

137
Q

which conditions can be affected by Jax heimer reaction

A

syphilis
HIV
lyme disease

138
Q

post HIV exposure proph

A

1 month 3 anti retrovirals

139
Q

marked eosinophilia of lamina propria= ?

A

eosinophilic gastroenteritis

140
Q

threadworms causative organism

A

enterobius vermicularis

141
Q

what to check when checking if hep b vaccine works

A

Anti-HBs

142
Q

most common cause of visceral larva migrans

A

toxocara canis

143
Q

yersinia =?
treatment

A

bacterial cause of diarrhoea

sensitive to quinolones, tetracyclines, co trimoxaxole

eg gentamicin ( if no renal problems), ofloxacin, ciprofloxacin

144
Q

bacterial vaginosis morphology

A

Gram positive coccobacilli

145
Q

Abx for severe diabetic foot infection/ ulcer - even if shows some fungal /anaerobic growth

A

IV CO AMOX – broad

M R C P (18 decks)

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