Main case 1

Question 1

Travellers diarrhoea bugs

Answer 1

Yersinia spp
Campylobacter spp
EHEC E. coli 0157:H7
Shigella spp
Salmonella spp

Question 2

Travellers diarrhoea tests

Answer 2

Stool for culture/ova/parasite
Urine culture
Blood culture
FBC
U&Es
CRP
LFT
HIV test (salmonella, shigella, campylobacter may indicate)

Question 3

Shigella and most travellers diarrhoea

Answer 3

Notifiable, but if no sepsis or dehydration can be managed at home
Resolve after 5-7 days
Inc oral fluids, rehydration salts
Only need Abx if Shigella bacteraemia with +ve blood culture

Commonly faecal-oral from contaminated food and water

Question 4

Campylobacter can be associated with

Answer 4

Guillan-Barre syndrome, 1-3 weeks after infection

Progressive weakness of the limbs, cranial nerves and resp muscles requiring ventilation

Question 5

Candida albicans in the sputum

Answer 5

Represents colonisation or contamination from oral Candida, doesn’t need to be covered by an antifungal if found when patient has eg pneumonia

Question 6

Common cause of candidaemia

Answer 6

Gut flora
- if epithelial lining becomes damaged microscopically (eg sepsis) or macroscopically (eg perforation, obstruction, necrosis)

Central/arterial lines may be another reason, but more common in preterm neonates

Question 7

Superficial fungal infections

Answer 7

Thrush - Candida
Tinea eg athlete’s foot (pedis) or ringworm (capitis)
Fungal nail infection - onychomycosis

Question 8

Deep fungal infections

Answer 8

Immunocompromised-
Invasive Candida eg candidaemia if central line
Invasive Aspergillus fumigatus - transplants or chemo
Pneumocystis jirovecii pneumonia (PCP) - HIV
Cryptococcal meningitis - HIV or other immunosuppression, from Cryptococcus neoformans

Question 9

Primary varicella zoster infection (chickenpox)

Answer 9

Widespread, itchy, vesicular rash (starting face/trunk)
Malaise, fever
Breathlessness, low SATs, tachypnoea
- affecting lungs causing pneumonitis
Other complications: bacterial infection of skin lesions, encephalitis, neuro problems, hepatitis, myocarditis

Question 10

Immunocompromise

Answer 10

Diabetes
HIV
Haematological disorders and malignancies
Extremes of age
Pregnancy
Systemic inflam conditions eg rheumatoid arthritis
Immunosuppressive meds

Question 11

Risk factors for varicella pneumonitis

Answer 11

Smoking
Pregnancy
Compromised immune system
Chronic lung disease

Question 12

Antiviral for VZV

Answer 12

Aciclovir

Question 13

Antiviral for influenza

Answer 13

Oseltamivir

Question 14

Herpes viruses

Answer 14

EBV - glandular fever, cancers eg Burkitt’s lymphoma
CMV - if immunocompromised eg tissue rejection
Herpes simplex virus 1 and 2 - ulcers

Question 15

Test for chickenpox immunity

Answer 15

VZV IgG

Question 16

If VZV IgG negative and pregnant, course of action?

Answer 16

Give VZV immunoglobulin (antibodies)

- provides temporary passive immunity

Question 17

VZV risk in pregnancy

Answer 17

Highest in 1st trimester for foetus

Highest in 3rd for mother

Question 18

TORCH infections

Answer 18

Associated with congenital abnormalities
TOxoplasma
Rubella
CMV
Herpes viruses

Question 19

Measles

Answer 19

Fever, malaise
Conjunctivitis
Cough
Koplik spots - blue/grey, inside buccal mucosa
Maculopapular rash starting on face

Question 20

Complications of measles

Answer 20

Bacterial pneumonia
Otitis media
Acute encephalitis

Question 21

Primary HIV infection

Answer 21

Generalised rash
Pharyngitis
Lymphadenopathy
Headache
Mouth ulcers
Flu-like symptoms

Question 22

Causes of eosinophilia

Answer 22

Asthma
Haematological malignancies
Eczema
Parasites - usually helminths
Drug allergy

Question 23

Malaria prophylaxis

Answer 23

Doxycycline

also atovaquine, mefloquine

Question 24

UK helminths

Answer 24

Pinworm - enterobius vermicularis

Diphyllobothrium latum or fish tape worm

Question 25

UK protozoa

Answer 25

Toxoplasma gondii
- reactivate in immunosuppressed
- in kitten faeces
- TORCH diseaes
Giardia lamblia
- faecal oral from contaminated water
- watery diarrhoea
Cryptosporidium parvum
- watery diarrhoea
Trichomonas vaginalis
- discharge

Question 26

UK ectoparasites

Answer 26

Scabies
Ticks
Lice

Question 27

Malawi infection

Answer 27

Schistosomiasis

- snails, penetrate the skin, migrate to the gut or bladder

Question 28

Serious Thailand infection

Answer 28

Strongyloidiasis

• don’t walk barefoot
• can reinfect the same patient for years

Question 29

Elephantiasis countries

Answer 29

Bangladesh
India
Indonesia
Democratic Republic of Congo
(Thailand)

Question 30

Elephantiasis - what is it

Answer 30

Filariasis
Worm species transmitted by mosquitos
Block lymphatic drainage

Question 31

Strongyloidiasis treatment

Answer 31

Ivermectin

Question 32

Risk factors for parasitic disease

Answer 32

Eating undercooked pork
HIV
Living in close proximity to animals
Walking barefoot in areas endemic for soil-transmitted helminths