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Medical Finals 2020 > Infective Diseases > Flashcards

Infective Diseases Flashcards

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USMLE® Step 1 flashcards
1
Q

Which vaccines are live attenuated?

A
  • BCG
  • MMR
  • Oral polio
  • Yellow fever
  • oral typhoid
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2
Q

What is Reiter’s Syndrome?

A
  • uveatis
  • arthritis
  • sexual infection
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3
Q

What are symptoms of chlamydia?

A
  • dysuria
  • frequency
  • discharge
  • lymphadenopathy
  • ulcers
  • warts
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4
Q

What antibiotics do you give for chlamydia?

A
  • doxycyline (NOT IF PREGNANT)

- azithromycin

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5
Q

What investigation do you do for ?chlamydia or ?gonorrhoea?

A
  • NAAT - 1st voice urine, triple swabs (cervical, vulvovaginal)
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6
Q

What is your treatment for gonorrhoea?

A
  • ciprofloxacin

- ceftriaxone with azithromycin

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7
Q

What is HIV seroconversion?

A

Initial illness - sore throat, malaise, myalgia, diarrhoea, lymphadenopathy, mouth ulcers

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8
Q

Why is HIV PCR repeated 4-weeks post-exposure?

A

It sometimes takes that long to become detectable. If negative at 4 weeks, repeat again at 12 weeks (ELISA looks for p24 antigen)

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9
Q

How do you treat malaria?

A

Falciparum - artesunate or quinine

Ovale/vivax - chloroquine

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10
Q

What can you give in malaria prophylaxis?

A

Doxycycline
Malarone
Methoquine

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11
Q

What investigations do you do in TB?

A 
CXR
Sputum culture
Bronchoscopy and lavage
Ziehl-neelson stain
Mantoux skin test
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12
Q

What are the four drugs used to treat TB and their main side effects?

A

Rifampicin - red urine, hepatotoxicity
Ethambutol - optic neuritis
Isoniazid - peripheral neuropathy
Pyrazinomaide - hepatotoxicity

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13
Q

What is the most common cause of a UTI?

A

E.coli

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14
Q

Give the name of some organisms that cause UTIs

A

E.coli
Klebsiella
Proteus

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15
Q

What would you want to do a first catch urine sample for?

A

Chlamydia or Gonorrhoea

Urethritis

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16
Q

What is your first line treatment in a UTI?

A

Nitrofurantoin

Trimethoprim

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17
Q

When do you not give nitrofurantoin?

A

poor renal function or last trimester

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18
Q

When is it pointless to do a urine dipstick on someone?

A

Elderly ladies over 65

Catheterised patients

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19
Q

What symptoms might someone with a UTI present with?

A 
Dysuria
Burning on passing urine
Cloudy urine
Frequency
Incontinence
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20
Q

What country doesn’t have a vaccination programme for Hepatitis B?

A

UK

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21
Q

Give some differentials for raised ALT, AST and bilirubin with jaundice and mildly raised ALP and GGT.

A

Hep B, Hep C, glandular fever, alcohol, Hep A

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22
Q

What is the best way to test liver function?

A

Clotting

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23
Q

Which viral hepatitis is a DNA virus?

A

Hep B

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24
Q

What are risk factors in the transmission of hepatitis B?

A

Blood and needle stick injuries
Sexually transmitted
Vertical transmission
Sharing razors or toothbrushes

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25
Q

How might a patient with viral hep B present?

A

Fever, jaundice, rigors and sweats
Joint pain
Dark urine, pale stools, bile and itching
Hepatosplenomegaly, spider naevi

Increased risk of hepatocellular carcinoma

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26
Q

What would you see in a screening test of someone who has been vaccinated against Hepatitis B?

A

HbsAb

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27
Q

HbsAg means…

A

Hep B surface antigen

They have the active disease - either acutely or chronically, it may not appear immediately

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28
Q

What would you see in a hep B screen of someone who has chronic Hep B?

A 
Surface antigen (HbsAg)
Core antibody (HbcAb)
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29
Q

What are the 4 stages of a Hep B infection?

A

Immune Tolerance - high levels of viral replication, low levels of immune system
Immune Clearance - high levels of immune reaction
Inactive Carrier Phase - virus levels decreased
Reactivation Phase - inflammation occurs, fibrosis develops

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30
Q

What treatments exist for Hep B?

A

Pegylated interferon-alpha 2a

Nucleotide analogues: Tenofovir or Entecavir

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31
Q

When is the Hep B vaccine given in children of woman who have the virus?

A

1, 7 and 21 weeks

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32
Q

Is Hep C curable and what is the name of the drug class used?

A

Yes
Direct Acting Antivirals (DAAs)
Telaprevir, Boceprevir

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33
Q

What can you use in Hep B/C to see the progression of liver cirrhosis?

A

Fibroscan - USS of the liver, measures the ‘stiffness’

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34
Q

What bloods tests confirm Hepatitis C?

A

Hep C antibody

Hep C RNA

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35
Q

What are the main causes for Hep C transmission?

A

IVDU
Tattoos
Needle stick injuries, BBV

36
Q

What are the most common genotypes of Hep C?

A

1 and 3

37
Q

What are two essential questions to ask someone returning from travel with a fever?

A

Malaria prophylaxis?

Unwell contact?

38
Q

What does PCP stand for and what does it cause? Who is at risk?

A

Pneumocystis jiroveci pneumonia
Fungal infection
Occurs in people with immunocompromise (HIV)

39
Q

What treatment do you give for PCP?

A

Co-trimoxazole (not clotrimazole which is used for fungal infections)
Investigations: bronchiolar lavage, throat swab, sputum culture

40
Q

What bacteria causes TB?

A

Mycobacteria tuberculosis

41
Q

What are risk factors for TB?

A 
Overcrowding, poor housing, homelessness
Alcohol, diabetes
Chronic lung disease
Malnutrition
Immunosuppression, HIV
42
Q

What differentials exist for cellulitis?

A

DVT + PE

Necrotising fasciitis

43
Q

What are your differentials for a blistering rash and how might you investigate?

A

Shingles, herpes simplex (type 1 - cold sores, type 2 - genital), varicella zoster
Ix: PCR HSV or VZ, viral swab (green), bacterial swab (black)

44
Q

What test do you do to determine malaria count and type?

A

Malaria phylum
Thick and thin film
Thick - malaria diagnosis
Thin - determines the count and morphology

45
Q

What is treponema pallidum and some key symptoms?

A

Syphylis
Mouth ulcers, penile ulcers, inguinal lymphadenopathy
Rash on trunk, palms and soles
‘Snail track’ buccal ulcers

Primary features - chancre - painless ulcer, non-tender lymphadenopathy

46
Q

What is the biggest risk for Hepatitis E?

A

Raw or undercooked pork

Wild boar, venison

47
Q

What are red flags for necrotising fasciitis?

A

Worsening cellulitis with pain out of keeping with physical features

48
Q

What are the two different types of necrotising fasciitis?

A

Type 1 - mixed anaerobes and aerobes

Type 2 - strep pyogenes

49
Q

What are complications of gonorrhoea in males and females?

A

Males - urethral stricture, epididymitis, salpingitis (infertility)
Females - bartholin’s abscess, PID

Systemic complication - peri-hepatitis, reactive arthritis

50
Q

What are the 4 subspecies of malaria?

A

P. falciparum
P. vivax
P. ovale
P. malariae

51
Q

Give 5 symptoms of malaria

A

Severe headache
Fever
Hepatosplenomagaly
Haemolysis - jaundice, diarrhoea and vomiting

52
Q

What is considered severe malaria?

A

> 2%

53
Q

Give 3 drugs you can give to treat malaria?

A

Quinine
Artesunate
Primaquine

54
Q

Give the name of 3 malaria prophylactic drugs

A

Doxycycline
Malarone
Methoquine

55
Q

What are some important respiratory conditions in which you should consider underlying HIV as a diagnosis?

A 
PCP
TB
Kaposi's Sarcoma
Pneumonia
Cryptococcus
Toxoplasma
56
Q

How is HIV transmitted?

A 
Sexually
Vertically
Blood products
IV drug use
Needlestick injuries
57
Q

What CD4 count is considered AIDS?

A

CD4<200

Acquired Immune Deficiency Syndrome

58
Q

What investigation is done for HIV?

A

ELISA - looks for antibody and antigen
Virus can take 2-3 weeks to develop so if negative, repeat 4 weeks later

Can also do CD4 and viral load to monitor disease

59
Q

What is the chance a pregnant woman with HIV could pass the virus to her unborn child?

A

Without treatment 15-45%

With antiretroviral treatment the risk drops to below 5%

60
Q

What is the name for the group of drugs used to treat HIV?

What is the usual combination given?

A

HAART
Highly Active Antiretroviral Therapy

2 NRTI (nucleoside reverse transcriptase inhibitors) + a protease inhibitor/non-NRTI

61
Q

Give an example of a NRTI, PI and NNRTI

A

Tenofovir/Abacavir

Ritonavir

Nevirapine

62
Q

What procedure should be done in pregnant woman with HIV to prevent transmission to the baby?

A

Caesarean

63
Q

What is the difference between meningitis and meningococcal septicaemia?

A

Meningitis - inflammation of the meninges

Meningococcal septicaemia - bacterial infection with neisseria meningitides

64
Q

What are the 3 symptoms in meningism?

A

Photophobia
Neck stiffness
Headache

65
Q

What is Kernig’s and Brudzinski’s sign?

A

Kernig’s - inability to straighten leg while hips are flexed

Brudzinski - flexion of the hip/or knee on neck flexion

66
Q

A patient present with a non-blanching purpuric rash to A&E. What is your order of management?

What would you do if you were in the community?

A

Ceftriaxone 2-4mg IV
Blood cultures - do not delay treatment to do these

BenPen IM

67
Q

What are indications to delay a LP in a patient with meningitis?

A

Severe sepsis, rash
Resp or cardiac compromise
Raised ICP risk
Thrombocytopenia or coagulopathy

68
Q

What would you expect to see in a LP showing bacterial meningitis?

A

Polymorphs
High white cells
Turbid
Low glucose and raised protein

69
Q

What is looked at in a lumbar puncture?

A

Cell types, white cell count, appearance, glucose, protein and gram stain

70
Q

What would you expect to see in a LP showing viral meningitis?

A

Lymphocytes, high white cells, clear, normal glucose and protein

71
Q

What are some common causative organisms of bacterial meningitis?

A 
Neisseria meningitis
TB
H. influenza
Group B strep
Listeria
E. coli

(last 3 are common causes of neonate infection)

72
Q

What is given to families in meningitis prophylaxis?

A

Ciprofloxacin

Rifampicin

73
Q

What are some common causes of viral meningitis?

A

Enterovirus
Herpes simplex
Varicella Zoster

74
Q

What is your management of viral meningitis?

A

Acylovir if herpes

Supportive - paracetamol, ibuprofen

75
Q

A fever and new onset murmur is what until proven otherwise?

A

Endocarditis

76
Q

What are the number and virus associated with genital warts and cervical cancer?
Genital herpes?

A

Genital Warts - HPV 6 and 11
Cervical Cancer - HPV 16 and 18
HSV - herpes simplex virus - 1 (cold sores) and 2 (genital)

77
Q

What is the window for giving post-exposure prophylaxis in HIV exposure?

A

72-hour window

78
Q

What are the 4 species of plasmodium that cause disease in humans? What cell types does it affect?

A

P. falciparum, p. vivax, p. ovale, p. malariae

Hepatocytes, erythrocytes

79
Q

What do seizures in malaria indicate?

A

Cerebral malaria

80
Q

What complications can occur in malaria?

A

Hypoglycaemia
Acute renal failure
Respiratory distress
Severe anaemia

81
Q

What vaccines are live attenuated?

A

BCG, MMR, oral polio, yellow fever, oral typhoid

82
Q

Patients with a CD4 count lower than 200 should receive prophylactic treatment for what?

A

Co-trimoxazole for pneumocystis juroveci pneumonia

83
Q

What laboratory tests are done to look at different sexually transmitted diseases

A

Urethral gonorrhoea and chlamydia – urine nucleic acid amplification test (NAAT)
Syphilis – VDRL (venereal disease research laboratory) and RPR (rapid plasma reagain)

84
Q

What is the most common complication of measles?

A 
Otitis media
Pneumonia – common cause of death
Encephalitis
Diarrhoea
Subacute sclerosing panencephalitis
Myocarditis
85
Q

What drug therapy do you start in HIV?

A

Highly active antiretroviral theraphy (HAART)
2 Nucleotide reverse transcriptase inhibitors (NRTI) : 1 Non-nucleotide reverse transcriptase inhibitor (NNRTI or 1 Protease inhibitor (PI)

86
Q

What is HIV and how does it replicate?

A

Retrovirus with double stranded RNA
It attaches to CD4 receptors on t-helped cells and inserts RNA into the host cells using reverse transcriptase. The DNA is then inserted into the host sequence and the viral DNA replicated.

87
Q

What prophylactic treatments can be given to HIV patients and what are they for?

A

Co-trimoxazole - toxoplasmosis and PCP
Azithromycin - MAI
Pentamidine - PCP
Ganciclovir - active CMV

Medical Finals 2020 (25 decks)

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