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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
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
26
How is bartonella species transmitted?
Lutzomia sand fly
27
Risk factors for Bartonella?
Other persons in house infected Young age Hx of sandfly bites
28
Rx of Bartonella?
Ciprofloxacin +/- Azithromycin
29
∆∆ 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)
30
∆∆ eosinophilic meningitis
Angiostrongylus cantonensis Gnathostoma spinnigerem Toxocara Baylisascaris Cysticercosis ABCTG Drug allergy
31
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
32
What tests can you do if you suspect an eosinophilic meningitis with a parasite?
Serology PCR
33
∆∆ skin lesion with fever following travel to Thailand, with gram negative bacilli rod on gram stain.
plague brucellosis tularaemia scrub typhys typhoid fever meiliodosis
34
What is the organism for meilioidosis?
Burkholderia pseudomallei
35
How do you treat meilioidosis?
Meropenem Oral co-trimoxazole as secondary prophylaxis
36
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
37
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
38
∆∆ 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)
39
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
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
41
∆ for Rickettsia?
Lymphopenia, raised CRP, thrombocytopenia, deranged liver enzymes - all mild Definitive: Serology or PCR
42
29 yr old male with fever, abdominal pain, jaundice, hepatosplenomegaly, hypotension. ∆∆?
Leptospirosis Yellow fever Dengue Rift Valley fever*** Malaria Hepatitis Obstruction - amoeba, parasite
43
Rift Valley fever - key presenting features?
Zoonotic disease, makes animals sick Presents with liver failure Almost always presents with large joint arthralgia
44
What is the difference between the arthralgia in Chickungunya and Rift Valley fever?
Chickungunya small joint Rift Valley large joint
45
What is the Rx of visceral leishmaniasis?
Liposomal amphoterecin B and miltefosine
46
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)
47
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
48
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
49
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
50
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.
51
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
52
Name the organism and the Rx. Painless lesions in a Chinese chef with concomitant uveitis and hepatitis.
***Treponema palladium ***Penicillin
53
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
54
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
55
What causes actinomycetoma classically? How do you Rx?
Nocardia, streptomyces (white grains), actinomadura (red grain) Co-trimoxazole or aminoglycoside
56
What is the most common cause of mycetoma?
Bacterial - actinomycetoma
57
Name the species and the Rx
Promastigotes, leishmaniasis
58
What is this?
Leishmaniasis
59
What is this?
Leishmaniasis - amastigotes
60
What is this?
Epimastigote, trypanosomiasis Careful -may mistake for leish because kinetoplast is slightly anterior to nucleus but if like this it is amastigote!
61
Post arrival screening for immigrants - common elements?
Strongy Parasites and eosinophils TB Hep B and C HIV Immunity Non comm diseases - anaemia, mental health
62
Greatest risk factors of reactivation of TB?
<5 yrs in host country Previous TB on CXR HIV Children
63
Lifetime risk of reactivation of latent TB?
5-10%
64
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
65
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"
66
dense fibrosis ("woody"), draining sinus with "sulfur granules" - diagnosis?
Actinomyces spp Chronic infections, supparative and discharging Oral cavity, GU, GI
67
Rx of actinomyces?
Penicillin
68
∆∆ 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
69
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
70
What is this?
Bartonella henslae Starry appearance
71
Name the diagnosis. Where else does this disease effect?
CMV retinitis -Proctitis -Oesophagus
72
What is the diagnosis?
Toxoplasmosis
73
Cause of central nasal swelling and soft palate involvement, Russel bodies on biopsy?
Klebsiella rhinoscleromatis Rhinoscelorma
74
4 organisms caused by faeces from a vector on skin
Rickettsia prowasaki - lice Rickettsia typhi - flea Borrelia Recurrentis Trypanasoma Cruzi
75
Organisms from a tick bite
Rickettsia Africae Rickettsia Rickettsia Rickettsia Cornorii
76
What is transmitted by a Chigger?
Orientia Tshushugamushi - mite
77
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
78
Ashdown Agar growing cornflower lesions, organism?
Burkholderia Pseudomaleii
79
What causes bipolar staining?
BURY PAT Burkholderia Yersinia Pestis Pasturella Turalaeima
80
Rx of melioidosis?
Meropenem/Ceftazidime for 2 weeks Long course co-trimoxazole eradication
81
Sudden onset headache and eosinophilia in CSF analysis?
Angiostrongylus cantonensis Baylisascaris procynis Gnathostoma spingerum - Blood on LP
82
Incubation period of angiostrongylus? Which organs affected?
2-36 days Eye, CNS, lungs
83
Management of Angiostronyglus?
2 weeks prednisolone*** high dose, long course albendazole
84
∆∆ of umbilicate lesions on skin in HIV positive patient
Cryptococcus Talaromyces (DMF) Histoplasma (DMF) Molluscum Syphilis
85
Appearance of talaromyces marneffei
Budding central separations (Blasto also Broad Based Budding)
86
What are the dimorphic fungi?
Sporo Talaromyces Histo Cocci Paracocci Blasto
87
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
88
Clinical presentation of talaromyces?
Similar to histo Umbilicated skin lesions
89
Rx of dimorphic fungi? What about HIV?
Ampho B induction Itraconazole CD4 for 6 months until stop the itraconazole
90
Murine typhus also called? Prowazaki also called?
Endemic typhus. Epidemic typhus
91
First line Rx for salmonella typhi? Where is XDR prevalent?
Azithromycin (with carbapenem if think it is XDR) Pakistan
92
Typhoid complications when?
2-3 weeks Kidney Liver GI bleeding, perforation
93
Which organisms cause auto infection?
Strongy Enterobius Taenia Solium Hymenolepsis nana Cryptosporidium hominus
94
Intraerythrocytic pathogens?
Bartonella bacilliformis Bartonella henslae Falciparum species Babesia species

Trop Med (49 decks)

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