MCQ Nuggets Flashcards
What are the most common causes of splenomegaly in the developing world?
Schistosomiasis
Visceral leish
Hyperreactive malaria (kids)
Brucellosis
What are the classic common causes of undifferentiated fever of any cause?
Malaria
Typhoid
Viral haemorrhagic fever
Causes of sporotrichoid pattern of skin disease?
Chronic lymphangitic rash
Sporothrix schenckii**
Mycobacterium marinum**
Nocardia brasiliensis*
M. abscessus/chelonae*
Mycobacterium kansasii*
Nocardia asteroides*
Cutaneous leishmaniasis*
General principles of treating NTM
*Clarithromycin,azithromycin
* Rifampin, rifabutin
* Doxycycline, minocycline, and quinolones
* Cefoxitin
* Amikacin
* Ethambutol
Combination therapy is typical, particularly in
IC patients
Rx is long (yrs often), end point of therapy not clear
What is the pattern of TB on CXR in
- HIV
- Primary infection
-Activation of latent TB
HIV - diffuse infiltrates
Primary - middle and lower lobes
Reactivation - upper lobes and peri hilar
12 yr old female with headache and seizures, dysarthria and photophobia.
Lives in Cusco, farm.
Single enhancing lesion on MRI brain. See a scolex.
∆ and Rx?
Neurocysticercosis
Do not need any further tests.
AEDs
ABZ plus steroids
24 yr old female with intellectual impairment with seizures since aged 8 yo. Rx phenytoin, recurrent seizures.
Multiple cystic lesions on CT, some calcified, in ventricles, parenchyma and SA space
∆ and Rx?
Removal of neuroendoscopy
AEDs - optimise
ABZ and PZQ
Steroids
28 y o male with 2 yr hx of intermittent severe headache, now presenting with left hemiparesis. CT ∆ NCC, dex and albendazole Rx.
MRI - right sided lacunar infarcts and hydrocephalus. Cyst in 3rd vent and basal cisterns
∆ and Rx?
NCC in subarachnoid space (basal cisterns) can cause vasculitis and hydrcephalus
Dex, AEDs, Acetazolamide, mannitol
Shunt
ABZ and PZQ
Consideration of removal of cyst
In that order
What is Brun’s syndrome?
Intermittent CSF flow blockage with change of position from an intermittent obstructing NCC
What is Brun’s syndrome?
Intermittent CSF flow blockage with change of position from an intermittent obstructing NCC
How would you treat SA NCC and cerebral oedema?
Steroids, AEDs, ABZ and PZQ when ICP under control
Will need long course of steroids - consider steroid sparing agents.
27 yr old arriving in Cusco from USA. SOB and headache and cough, pink frothy sputum. Spo2 64%.
High altitude pulmonary oedema
How do you diagnose AMS?
3 or more points from 4 rated symptoms, including at least headache
Also
- GI symptoms
- Fatigue
- Dizziness
AMS 3-5 mild, 6-9 moderate, 10-12 severe
How do you ∆ HACE?
AMS + Altered mental status or Ataxia
How do you ∆ HAPE?
Two symptoms of SOB, cough, weakness, chest tightness
Tow signs: wheeze, cyanosis, tachypnoea, tachycardia
What are RFs for AMS?
Rate of ascent
Previous hx of AMS
Not sleeping at altitude
Age
Comorbidities (raised PASP)
Prevention of AMS?
Acetazolamide
Dexamethasone
Nifedipine
20 yr old student from US travelled to Bolivia now with single nodular painful lesion on heel, red. ∆?
Cutaneous myiasis
South America - Dermatobia hominis
Other: cordylobia species
Most common in Bolivia
What is the difference between Dermatobia hominis and cordylobia species?
Dermatobia hominis
- Americas
- Eggs in mosquitos
- Exposed area
- Single lesion or 2-3
Cordylobia species
- Africa
- Eggs in clothes
- Covered areas
- Multiple lesions
How do you treat furuncular myiasis?
Surgical removal vs occlusion
Tetanus vaccine
Secondary bacterial infection might need ABx
∆∆ for migrating rash and eosinophilia?
Gnathosomiasis
Strongy (larvae Currans)
Paragonimus
Ancylostoma (cutaenous larvae migrans)
Fasciola (rare)
28 yr old male, visited Peru, ate raw fish and then developed a migrating rash on abdomen with fever and constipation. ∆ and Rx?
Gnathostomiasis
How do humans catch gnathostoma
Humans - ingestion of freshwater fish (intermediate hose) and birds -paratenic host (dead end)
Rx of gnathostoma
Ivermectin and albendazole
6 yr old boy with fever, weakness, pallor and headache. Lived in cusco, has pigs, cows and sheep at home.
On Ex: febrile, lethargic, pale, mild jaundice. ∆?
Bartonella Bacilliformis - found at Altitude in Peru, Columbia, Brazil
Infect RBCs and causes haemolysis.
carrions disease
- acute haematic phase - Oroya fever
- second phase - verruga peruna - red nodular appearance
How is bartonella species transmitted?
Lutzomia sand fly
Risk factors for Bartonella?
Other persons in house infected
Young age
Hx of sandfly bites
Rx of Bartonella?
Ciprofloxacin +/- Azithromycin
∆∆ of migrating rash
Stongy - larva currens - like a strong current - strught line and fast moving
Gnathastomia - haemorrhagic and often leaves small brusing
Fasciola - rare but can do it
Scabies - burrowing tracts
Dirofilaria
(Baylisascariasis and Toxocara are visceral larva migrans)
∆∆ eosinophilic meningitis
Angiostrongylus cantonensis
Gnathostoma spinnigerem
Toxocara
Baylisascaris
Cysticercosis
ABCTG
Drug allergy
7 yr old boy eating slugs, presents with headache and vomiting, CSF shows raised WCC but normal biochemistry, CSF WCC shows raised eosinophils. ∆?
Angiostrongylus cantonensis
Eating unwashed lettuce (slime from slugs)
Lung rat worm
What tests can you do if you suspect an eosinophilic meningitis with a parasite?
Serology
PCR
∆∆ skin lesion with fever following travel to Thailand, with gram negative bacilli rod on gram stain.
plague
brucellosis
tularaemia
scrub typhys
typhoid fever
meiliodosis
What is the organism for meilioidosis?
Burkholderia pseudomallei
How do you treat meilioidosis?
Meropenem
Oral co-trimoxazole as secondary prophylaxis
How can you contract meilioidosis? Where do
Environmental pathogen
Water based, in rainy season in tropics (Northern Aus, South East Asia)
Transmission through skin or ingestion
How does meilioidosis present?
Sepsis syndrome in acute form with abscesses
Tends to form abscesses (prostate, spleen, kidney, liver, bone)
TB like picture chronic infection
∆∆ cruise ship worker from India in carribean presenting with fever, abdominal pain, myalgia, fever, chills. Deranged LFTs. Liver hypodensity on CT.
E.Histolytica
Typhoid with complication
Pyogenic abscess - klebsiella pneumoniae (causes liver abscesses - certain serotype)
45 yr old male works as a air steward, travelled to Nigeria and then USA. Presents with fever, headache, SOB, peripheral oedema, low GCS. Multi organ failure with ARDS on CXR, kidney and renal failure, with plts 22. Most likely ∆?
Falciparum malaria - complicated
40 yr old female with febrile illness following visit to Kruger, lots of mosquito bites. On ex - welts on skin.
Rickettsia Africae
African tick bite fever
Spotted fever group (R. rickettsia, R.Afrciae)
Typhus group (R.typhys)
Scrub Typhus
∆ for Rickettsia?
Lymphopenia, raised CRP, thrombocytopenia, deranged liver enzymes - all mild
Definitive: Serology or PCR
29 yr old male with fever, abdominal pain, jaundice, hepatosplenomegaly, hypotension. ∆∆?
Leptospirosis
Yellow fever
Dengue
Rift Valley fever***
Malaria
Hepatitis
Obstruction - amoeba, parasite
Rift Valley fever - key presenting features?
Zoonotic disease, makes animals sick
Presents with liver failure
Almost always presents with large joint arthralgia
What is the difference between the arthralgia in Chickungunya and Rift Valley fever?
Chickungunya small joint
Rift Valley large joint
What is the Rx of visceral leishmaniasis?
Liposomal amphoterecin B and miltefosine
Name the organism and the Rx. Peruvian farmer with ulcer on hand for 2 days with SOB, headache and shock.
Lesion, rapidly progressing
Raised border, white border
Significant surrounding oedema
Tender regional lymphadenopathy
Non painful ulcer
CXR - haemorrhagic mediastinitis with pleural effusion, no lobar pneumonia
**Bacillus anthracis - meningitis
**Penicillin + ciprofloxacin + linezolid/clinda + antitoxins (IgG)
Name the organism and the Rx. Peurvian farmer with 2 week history of painful lesion with some smaller lesions tracking up the arm.
**Sporotrix schenkii
**Itraconazole
∆∆ leishmania
NTM
Nocardia
Tularemia - Francisella tularensis - rats
Can also use SSKI and Terbinafine but not exam number
Name the organism and the Rx. 50 yr old Peruvian with a slow growing painful ulcer over 12 months.
Usually painless
Undermined border
But this one is hyperinfected therefore painful.
**Mycobacterium ulcerans
** Rifampicin and clarithromycin
Name the organism and the Rx. Painless lesion developing over 1 week in Brazilian.
Ulcer with raised border, no necrosis, granulomatous tissue, farmer.
Satellite lesions.
**Leishmania Braziliensis
**Pentavelent antimonials
Name the organism and the Rx. Painful lesion over 2 days in a Peruvian male.
Plate like lesion, 3 colours. Black centre with white border, and surrounding erythema. Small vesicles In centre.
Very painful, develops over 1-2 days.
**Loxosceles laeta (Spp)
**Rx none. Can use anti venom - no conclusive evidence. Can cause anaphylaxis.
Name the organism and the Rx. Bolivian lady with 6 month history of pleuritic chest pain and fever.
Empyema necessitans
pleural eff opens through chest wall.
Actinomycosis
**Actinomyces species
**Penicillin
Name the organism and the Rx. Painless lesions in a Chinese chef with concomitant uveitis and hepatitis.
**Treponema palladium
**Penicillin
Name the organism and the Rx. 2 year history of suppuration and grains.
**Staph aureus
**Pencillin
Have to have trauma
Get it on face and back, hands
Caused by staph and pseudomonas
Farmers
Homeless man from Cusco 3 month history ear lobe lesions after head trauma and sensation that something is moving.
**cochliomyia hominivorax
**Ivermectin
∆∆Dermatobia hominus - furuncular myiasis, air bubbles
What causes actinomycetoma classically? How do you Rx?
Nocardia, streptomyces (white grains), actinomadura (red grain)
Co-trimoxazole or aminoglycoside
What is the most common cause of mycetoma?
Bacterial - actinomycetoma
Name the species and the Rx
Promastigotes, leishmaniasis
What is this?
Leishmaniasis
What is this?
Leishmaniasis - amastigotes
What is this?
Epimastigote, trypanosomiasis
Careful -may mistake for leish because kinetoplast is slightly anterior to nucleus but if like this it is amastigote!
Post arrival screening for immigrants - common elements?
Strongy
Parasites and eosinophils
TB
Hep B and C
HIV
Immunity
Non comm diseases - anaemia, mental health
Greatest risk factors of reactivation of TB?
<5 yrs in host country
Previous TB on CXR
HIV
Children
Lifetime risk of reactivation of latent TB?
5-10%
Common causes of toxic shock syndrome, presentation?
Staph aureus
Strep pyogenes
Clostridium sordellii
Presents with fever, rash and desquamation (1-2 weeks later) hypotension and shock
Presentation and characteristics of actinomyces?
Thin, branching (filamentous or beaded) Gram-positive anaerobes
Presents as chronic or discharging/sinus tract infections
dense fibrosis (“woody”), draining sinus with “sulfur granules”
dense fibrosis (“woody”), draining sinus with “sulfur granules” - diagnosis?
Actinomyces spp
Chronic infections, supparative and discharging
Oral cavity, GU, GI
Rx of actinomyces?
Penicillin
∆∆ of pleural effusion in the tropics?
TB - VERY Common
Paragonimiasis** (pH <7.1)
Cryptococcosis
Histoplasmosis
Amebiasis
Toxocariasis
Echinococcosis
Sparganosis
Gnathostomiasis
Other non infective causes: heart failure, cancer
Tests on pleural fluid if suspicious of a parasitic cause?
WCC - eosinophilia of fluid
Protein - pleural:serum protein >0.5 = exudate
Pleural:sputum LDH >0.6
Culture and gram stain
pH (low)
Glucose (low)
ADA level (TB)
Sputum analysis ova and parasites
What is this?
Bartonella henslae
Starry appearance
Name the diagnosis. Where else does this disease effect?
CMV retinitis
-Proctitis
-Oesophagus
What is the diagnosis?
Toxoplasmosis
Cause of central nasal swelling and soft palate involvement, Russel bodies on biopsy?
Klebsiella rhinoscleromatis
Rhinoscelorma
4 organisms caused by faeces from a vector on skin
Rickettsia prowasaki - lice
Rickettsia typhi - flea
Borrelia Recurrentis
Trypanasoma Cruzi
Organisms from a tick bite
Rickettsia Africae
Rickettsia Rickettsia
Rickettsia Cornorii
What is transmitted by a Chigger?
Orientia Tshushugamushi - mite
What are the causes of caveatting lesions on CXR?
-TB/NTM
-Staph aureus
-Strep pneumonia
-Klebsiella
-Nocardia
-Aspergillus
-Histo (dimorphic fungi)
-Cryptococcus
-Paragonimus
-Actinomyces
-Melioidosis
-Mucor
TANKS CRAMPD
Ashdown Agar growing cornflower lesions, organism?
Burkholderia Pseudomaleii
What causes bipolar staining?
BURY PAT
Burkholderia
Yersinia Pestis
Pasturella
Turalaeima
Rx of melioidosis?
Meropenem/Ceftazidime for 2 weeks
Long course co-trimoxazole eradication
Sudden onset headache and eosinophilia in CSF analysis?
Angiostrongylus cantonensis
Baylisascaris procynis
Gnathostoma spingerum - Blood on LP
Incubation period of angiostrongylus? Which organs affected?
2-36 days
Eye, CNS, lungs
Management of Angiostronyglus?
2 weeks prednisolone*** high dose, long course albendazole
∆∆ of umbilicate lesions on skin in HIV positive patient
Cryptococcus
Talaromyces (DMF)
Histoplasma (DMF)
Molluscum
Syphilis
Appearance of talaromyces marneffei
Budding central separations (Blasto also Broad Based Budding)
What are the dimorphic fungi?
Sporo
Talaromyces
Histo
Cocci
Paracocci
Blasto
Talaromyces marneffei appearance on Bx? Who gets it and when?
Yellow pink colonies red rings
Hyphae - look like bamboo
HIV CD4 <100
Rainy season, soil exposure
Clinical presentation of talaromyces?
Similar to histo
Umbilicated skin lesions
Rx of dimorphic fungi? What about HIV?
Ampho B induction
Itraconazole
CD4 for 6 months until stop the itraconazole
Murine typhus also called? Prowazaki also called?
Endemic typhus. Epidemic typhus
First line Rx for salmonella typhi? Where is XDR prevalent?
Azithromycin (with carbapenem if think it is XDR)
Pakistan
Typhoid complications when?
2-3 weeks
Kidney
Liver
GI bleeding, perforation
Which organisms cause auto infection?
Strongy
Enterobius
Taenia Solium
Hymenolepsis nana
Cryptosporidium hominus
Intraerythrocytic pathogens?
Bartonella bacilliformis
Bartonella henslae
Falciparum species
Babesia species
