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Trop Med > MCQ Nuggets > Flashcards

MCQ Nuggets Flashcards

1
Q

What are the most common causes of splenomegaly in the developing world?

A

Schistosomiasis
Visceral leish
Hyperreactive malaria (kids)
Brucellosis

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2
Q

What are the classic common causes of undifferentiated fever of any cause?

A

Malaria
Typhoid
Viral haemorrhagic fever

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3
Q

Causes of sporotrichoid pattern of skin disease?

Chronic lymphangitic rash

A

Sporothrix schenckii**
Mycobacterium marinum**
Nocardia brasiliensis*
M. abscessus/chelonae*
Mycobacterium kansasii*
Nocardia asteroides*
Cutaneous leishmaniasis*

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4
Q

General principles of treating NTM

A

*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

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5
Q

What is the pattern of TB on CXR in
- HIV
- Primary infection
-Activation of latent TB

A

HIV - diffuse infiltrates
Primary - middle and lower lobes
Reactivation - upper lobes and peri hilar

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6
Q

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?

A

Neurocysticercosis

Do not need any further tests.

AEDs
ABZ plus steroids

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7
Q

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?

A

Removal of neuroendoscopy

AEDs - optimise

ABZ and PZQ

Steroids

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8
Q

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?

A

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

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9
Q

What is Brun’s syndrome?

A

Intermittent CSF flow blockage with change of position from an intermittent obstructing NCC

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10
Q

What is Brun’s syndrome?

A

Intermittent CSF flow blockage with change of position from an intermittent obstructing NCC

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11
Q

How would you treat SA NCC and cerebral oedema?

A

Steroids, AEDs, ABZ and PZQ when ICP under control

Will need long course of steroids - consider steroid sparing agents.

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12
Q

27 yr old arriving in Cusco from USA. SOB and headache and cough, pink frothy sputum. Spo2 64%.

A

High altitude pulmonary oedema

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13
Q

How do you diagnose AMS?

A

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

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14
Q

How do you ∆ HACE?

A

AMS + Altered mental status or Ataxia

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15
Q

How do you ∆ HAPE?

A

Two symptoms of SOB, cough, weakness, chest tightness
Tow signs: wheeze, cyanosis, tachypnoea, tachycardia

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16
Q

What are RFs for AMS?

A

Rate of ascent
Previous hx of AMS
Not sleeping at altitude
Age
Comorbidities (raised PASP)

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17
Q

Prevention of AMS?

A

Acetazolamide
Dexamethasone
Nifedipine

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18
Q

20 yr old student from US travelled to Bolivia now with single nodular painful lesion on heel, red. ∆?

A

Cutaneous myiasis

South America - Dermatobia hominis
Other: cordylobia species

Most common in Bolivia

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19
Q

What is the difference between Dermatobia hominis and cordylobia species?

A

Dermatobia hominis
- Americas
- Eggs in mosquitos
- Exposed area
- Single lesion or 2-3

Cordylobia species
- Africa
- Eggs in clothes
- Covered areas
- Multiple lesions

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20
Q

How do you treat furuncular myiasis?

A

Surgical removal vs occlusion
Tetanus vaccine
Secondary bacterial infection might need ABx

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21
Q

∆∆ for migrating rash and eosinophilia?

A

Gnathosomiasis
Strongy (larvae Currans)
Paragonimus
Ancylostoma (cutaenous larvae migrans)
Fasciola (rare)

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22
Q

28 yr old male, visited Peru, ate raw fish and then developed a migrating rash on abdomen with fever and constipation. ∆ and Rx?

A

Gnathostomiasis

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23
Q

How do humans catch gnathostoma

A

Humans - ingestion of freshwater fish (intermediate hose) and birds -paratenic host (dead end)

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24
Q

Rx of gnathostoma

A

Ivermectin and albendazole

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25
Q

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. ∆?

A

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

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26
Q

How is bartonella species transmitted?

A

Lutzomia sand fly

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27
Q

Risk factors for Bartonella?

A

Other persons in house infected
Young age
Hx of sandfly bites

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28
Q

Rx of Bartonella?

A

Ciprofloxacin +/- Azithromycin

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29
Q

∆∆ of migrating rash

A

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)

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30
Q

∆∆ eosinophilic meningitis

A

Angiostrongylus cantonensis
Gnathostoma spinnigerem
Toxocara
Baylisascaris
Cysticercosis

ABCTG

Drug allergy

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31
Q

7 yr old boy eating slugs, presents with headache and vomiting, CSF shows raised WCC but normal biochemistry, CSF WCC shows raised eosinophils. ∆?

A

Angiostrongylus cantonensis

Eating unwashed lettuce (slime from slugs)

Lung rat worm

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32
Q

What tests can you do if you suspect an eosinophilic meningitis with a parasite?

A

Serology
PCR

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33
Q

∆∆ skin lesion with fever following travel to Thailand, with gram negative bacilli rod on gram stain.

A

plague
brucellosis
tularaemia
scrub typhys
typhoid fever
meiliodosis

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34
Q

What is the organism for meilioidosis?

A

Burkholderia pseudomallei

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35
Q

How do you treat meilioidosis?

A

Meropenem

Oral co-trimoxazole as secondary prophylaxis

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36
Q

How can you contract meilioidosis? Where do

A

Environmental pathogen
Water based, in rainy season in tropics (Northern Aus, South East Asia)
Transmission through skin or ingestion

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37
Q

How does meilioidosis present?

A

Sepsis syndrome in acute form with abscesses
Tends to form abscesses (prostate, spleen, kidney, liver, bone)

TB like picture chronic infection

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38
Q

∆∆ cruise ship worker from India in carribean presenting with fever, abdominal pain, myalgia, fever, chills. Deranged LFTs. Liver hypodensity on CT.

A

E.Histolytica
Typhoid with complication
Pyogenic abscess - klebsiella pneumoniae (causes liver abscesses - certain serotype)

39
Q

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 ∆?

A

Falciparum malaria - complicated

40
Q

40 yr old female with febrile illness following visit to Kruger, lots of mosquito bites. On ex - welts on skin.

A

Rickettsia Africae

African tick bite fever

Spotted fever group (R. rickettsia, R.Afrciae)
Typhus group (R.typhys)
Scrub Typhus

41
Q

∆ for Rickettsia?

A

Lymphopenia, raised CRP, thrombocytopenia, deranged liver enzymes - all mild

Definitive: Serology or PCR

42
Q

29 yr old male with fever, abdominal pain, jaundice, hepatosplenomegaly, hypotension. ∆∆?

A

Leptospirosis
Yellow fever
Dengue
Rift Valley fever***
Malaria
Hepatitis
Obstruction - amoeba, parasite

43
Q

Rift Valley fever - key presenting features?

A

Zoonotic disease, makes animals sick
Presents with liver failure
Almost always presents with large joint arthralgia

44
Q

What is the difference between the arthralgia in Chickungunya and Rift Valley fever?

A

Chickungunya small joint

Rift Valley large joint

45
Q

What is the Rx of visceral leishmaniasis?

A

Liposomal amphoterecin B and miltefosine

46
Q

Name the organism and the Rx. Peruvian farmer with ulcer on hand for 2 days with SOB, headache and shock.

A

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)

47
Q

Name the organism and the Rx. Peurvian farmer with 2 week history of painful lesion with some smaller lesions tracking up the arm.

A

**Sporotrix schenkii
**Itraconazole

∆∆ leishmania
NTM
Nocardia
Tularemia - Francisella tularensis - rats

Can also use SSKI and Terbinafine but not exam number

48
Q

Name the organism and the Rx. 50 yr old Peruvian with a slow growing painful ulcer over 12 months.

A

Usually painless
Undermined border
But this one is hyperinfected therefore painful.

**Mycobacterium ulcerans
** Rifampicin and clarithromycin

49
Q

Name the organism and the Rx. Painless lesion developing over 1 week in Brazilian.

A

Ulcer with raised border, no necrosis, granulomatous tissue, farmer.
Satellite lesions.

**Leishmania Braziliensis
**Pentavelent antimonials

50
Q

Name the organism and the Rx. Painful lesion over 2 days in a Peruvian male.

A

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.

51
Q

Name the organism and the Rx. Bolivian lady with 6 month history of pleuritic chest pain and fever.

A

Empyema necessitans
pleural eff opens through chest wall.

Actinomycosis

**Actinomyces species
**Penicillin

52
Q

Name the organism and the Rx. Painless lesions in a Chinese chef with concomitant uveitis and hepatitis.

A

**Treponema palladium
**Penicillin

53
Q

Name the organism and the Rx. 2 year history of suppuration and grains.

A

**Staph aureus
**Pencillin

Have to have trauma
Get it on face and back, hands

Caused by staph and pseudomonas
Farmers

54
Q

Homeless man from Cusco 3 month history ear lobe lesions after head trauma and sensation that something is moving.

A

**cochliomyia hominivorax
**Ivermectin

∆∆Dermatobia hominus - furuncular myiasis, air bubbles

55
Q

What causes actinomycetoma classically? How do you Rx?

A

Nocardia, streptomyces (white grains), actinomadura (red grain)

Co-trimoxazole or aminoglycoside

56
Q

What is the most common cause of mycetoma?

A

Bacterial - actinomycetoma

57
Q

Name the species and the Rx

A

Promastigotes, leishmaniasis

58
Q

What is this?

A

Leishmaniasis

59
Q

What is this?

A

Leishmaniasis - amastigotes

60
Q

What is this?

A

Epimastigote, trypanosomiasis

Careful -may mistake for leish because kinetoplast is slightly anterior to nucleus but if like this it is amastigote!

61
Q

Post arrival screening for immigrants - common elements?

A

Strongy
Parasites and eosinophils
TB
Hep B and C
HIV
Immunity
Non comm diseases - anaemia, mental health

62
Q

Greatest risk factors of reactivation of TB?

A

<5 yrs in host country
Previous TB on CXR
HIV
Children

63
Q

Lifetime risk of reactivation of latent TB?

A

5-10%

64
Q

Common causes of toxic shock syndrome, presentation?

A

Staph aureus
Strep pyogenes
Clostridium sordellii

Presents with fever, rash and desquamation (1-2 weeks later) hypotension and shock

65
Q

Presentation and characteristics of actinomyces?

A

Thin, branching (filamentous or beaded) Gram-positive anaerobes
Presents as chronic or discharging/sinus tract infections

dense fibrosis (“woody”), draining sinus with “sulfur granules”

66
Q

dense fibrosis (“woody”), draining sinus with “sulfur granules” - diagnosis?

A

Actinomyces spp
Chronic infections, supparative and discharging
Oral cavity, GU, GI

67
Q

Rx of actinomyces?

A

Penicillin

68
Q

∆∆ of pleural effusion in the tropics?

A

TB - VERY Common
Paragonimiasis** (pH <7.1)
Cryptococcosis
Histoplasmosis
Amebiasis
Toxocariasis
Echinococcosis
Sparganosis
Gnathostomiasis

Other non infective causes: heart failure, cancer

69
Q

Tests on pleural fluid if suspicious of a parasitic cause?

A

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

70
Q

What is this?

A

Bartonella henslae
Starry appearance

71
Q

Name the diagnosis. Where else does this disease effect?

A

CMV retinitis

-Proctitis
-Oesophagus

72
Q

What is the diagnosis?

A

Toxoplasmosis

73
Q

Cause of central nasal swelling and soft palate involvement, Russel bodies on biopsy?

A

Klebsiella rhinoscleromatis
Rhinoscelorma

74
Q

4 organisms caused by faeces from a vector on skin

A

Rickettsia prowasaki - lice
Rickettsia typhi - flea
Borrelia Recurrentis
Trypanasoma Cruzi

75
Q

Organisms from a tick bite

A

Rickettsia Africae
Rickettsia Rickettsia
Rickettsia Cornorii

76
Q

What is transmitted by a Chigger?

A

Orientia Tshushugamushi - mite

77
Q

What are the causes of caveatting lesions on CXR?

A

-TB/NTM
-Staph aureus
-Strep pneumonia
-Klebsiella
-Nocardia
-Aspergillus
-Histo (dimorphic fungi)
-Cryptococcus
-Paragonimus
-Actinomyces
-Melioidosis
-Mucor

TANKS CRAMPD

78
Q

Ashdown Agar growing cornflower lesions, organism?

A

Burkholderia Pseudomaleii

79
Q

What causes bipolar staining?

A

BURY PAT
Burkholderia
Yersinia Pestis
Pasturella
Turalaeima

80
Q

Rx of melioidosis?

A

Meropenem/Ceftazidime for 2 weeks
Long course co-trimoxazole eradication

81
Q

Sudden onset headache and eosinophilia in CSF analysis?

A

Angiostrongylus cantonensis
Baylisascaris procynis
Gnathostoma spingerum - Blood on LP

82
Q

Incubation period of angiostrongylus? Which organs affected?

A

2-36 days
Eye, CNS, lungs

83
Q

Management of Angiostronyglus?

A

2 weeks prednisolone*** high dose, long course albendazole

84
Q

∆∆ of umbilicate lesions on skin in HIV positive patient

A

Cryptococcus
Talaromyces (DMF)
Histoplasma (DMF)
Molluscum
Syphilis

85
Q

Appearance of talaromyces marneffei

A

Budding central separations (Blasto also Broad Based Budding)

86
Q

What are the dimorphic fungi?

A

Sporo
Talaromyces
Histo
Cocci
Paracocci
Blasto

87
Q

Talaromyces marneffei appearance on Bx? Who gets it and when?

A

Yellow pink colonies red rings
Hyphae - look like bamboo

HIV CD4 <100
Rainy season, soil exposure

88
Q

Clinical presentation of talaromyces?

A

Similar to histo
Umbilicated skin lesions

89
Q

Rx of dimorphic fungi? What about HIV?

A

Ampho B induction
Itraconazole

CD4 for 6 months until stop the itraconazole

90
Q

Murine typhus also called? Prowazaki also called?

A

Endemic typhus. Epidemic typhus

91
Q

First line Rx for salmonella typhi? Where is XDR prevalent?

A

Azithromycin (with carbapenem if think it is XDR)
Pakistan

92
Q

Typhoid complications when?

A

2-3 weeks
Kidney
Liver
GI bleeding, perforation

93
Q

Which organisms cause auto infection?

A

Strongy
Enterobius
Taenia Solium
Hymenolepsis nana
Cryptosporidium hominus

94
Q

Intraerythrocytic pathogens?

A

Bartonella bacilliformis
Bartonella henslae
Falciparum species
Babesia species

Trop Med (49 decks)

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