Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

YEAR 6 > MED: Infectious Diseases > Flashcards

MED: Infectious Diseases Flashcards

1
Q

Clinical features of trichomonas?

A
  • vaginal discharge: offensive, yellow/green, frothy
  • vulvovaginitis
  • strawberry cervix
  • pH > 4.5
  • in men is usually asymptomatic but may cause urethritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Investigations for trichomonas?

A

microscopy of a wet mount shows motile trophozoites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Management for trichomonas?

A

oral metronidazole for 5-7 days
// one-off dose of 2g metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Management of a dog / human bite ?

A
  • Cleanse wound. Puncture wounds should not be sutured closed unless cosmesis is at risk
  • Co-amoxiclav
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Diagnostic criteria for BV?

A

Amsel’s criteria:
3 / 4 points should be present

  • Thin, white homogenous discharge
  • Clue cells on microscopy: stippled vaginal epithelial cells
  • Vaginal pH > 4.5
  • Positive whiff test (addition of potassium hydroxide results in fishy odour)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Management of BV?

A

Asymptomatic = no treatment required
Symptomatic = PO metronidazole 5-7d
topical metronidazole or topical clindamycin are alternatives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Pathogens causing cellulitis?

A

Streptococcus pyogenes (most common)
Staphylcoccus aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Management of cellulitis?

A
  • Mild / moderate = oral fluclox
  • Pen allergy = oral clarith, eryth (in pregnancy) or dox
  • Severe = admit + oral/IV co-amox, oral/IV clindamycin, IV cefuroxime / ceftriaxone
  • Mark the area of erythema to detect spreading cellulitis
  • If possible elevate the leg
  • Consider paracetamol or ibuprofen for pain or fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pathogen causing Chancroid ?

A

Haemophilus ducreyi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Clinical features of chancroid ?

A

Painful ulcers:

  • Lesion begins as erythematous tender papules
  • Become pustular and later erode to form an extremely painful and deep ulcer with soft ragged, undermined margins.
  • Deeper erosion occasionally leads to marked tissue destruction.
  • Males = foreskin, sometimes shaft / glans / meatus
  • Females = labia majora, sometimes labia minora / thighs / perineum / cervix

Inguinal lymphadenopathy:

  • Is painful

Other rare symptoms include dysuria and dyspareunia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Investigations for chancroid?

A

Usually clinical diagnosis

Culture and sensitivity:

  • Definitive diagnosis requires the identification of Haemophilus ducreyi on special culture media

PCR:

  • Most sensitive

Microscopy:

  • gram-negative bacillus which exhibits an unusual tendency to auto-agglutinate
  • “schools of fish,” “railroad tracks,” and “fingerprints”

Serology:

  • Serologic testing for syphilis and HIV and cultures for herpes should be done to exclude other causes of genital ulcers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Management for chancroid ?

A
  • Single IM dose (250 mg) ceftriaxone
  • Single IM dose (1gram) azithromycin
  • Oral (500 mg) erythromycin four times a day for seven days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Clinical features of Cutaneous larva migrans ?

A
  • Prevalent in tropical and subtropical regions
  • Intensely pruritic, ‘creeping’, serpiginous, erythematous cutaneous eruption that advances over time
  • Symptoms can last for weeks to months, potentially leading to secondary bacterial infection due to excessive scratching
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Management of cutaneous larva migrans ?

A
  • Anthelmintic agents, such as ivermectin or albendazole
  • Topical therapy with thiabendazole can also be effective
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Transmission of Dengue ?

A

Arbovirus transmitted by the aedes mosquito

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Transmission of cutaneous larva migrans ?

A

Transmission vectors are faecal-contaminated soil or sand, posing significant risks to individuals with a history of barefoot beach visits or direct soil contact.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Clinical features of non-severe Dengue ?

A

> >

  1. Non-severe dengue: fever followed by recovery

Without warning signs:

  • Fever with two of the following:
  • Nausea/vomiting
  • Rash
  • Aches and pains
  • Positive tourniquet test
  • Leukopenia

With warning signs:

  • Abdominal pain or tenderness
  • Persistent vomiting
  • Clinical fluid accumulation
  • Mucosal bleed
  • Lethargy
  • Restlessness
  • Liver enlargement >2cm
  • Increasing haematocrit with reducing platelets

The initial presentation of dengue is:

  • Intermittent high pyrexias ‘break-bone fever’ lasting 3-7 days
  • Arthralgia
  • Rash - typically blanching maculopapular erythematous rash similar to measles or scarlet fever, may develop into petechiae
  • Other bleeding manifestations - bleeding gums, epistaxis, GI bleeds

Other features may be quite non-specific and can include:

  • Headache
  • Nausea & vomiting
  • Lymphadenopathy
  • Generalised myalgia
  • Backache
  • Ocular manifestations - retro-orbital pain, conjunctival injection, conjunctivitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Clinical features of severe Dengue ?

A

»2. Severe dengue (5% of patients) dengue with severe plasma leakage, severe haemorrhage and severe organ impairment

Severe symptoms may include:

  • Pulmonary and facial oedema
  • Ascites
  • Pleural effusions
  • Meningism including photophobia
  • Worsening or more profuse haemorrhage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Investigations for Dengue ?

A

Bloods:

  • Thrombocytopenia
  • Leucopenia
  • Haematocrit can be a useful monitoring tool, with increasing haematocrit often reflective of clinical deterioration.
  • Prolonged APTT and PT
  • Deranged U&E’s
  • Elevated LFTs especially AST

Diagnosis can be confirmed by:

  • Viral isolation from serum - sample needs to be collected early during the viraemic period (before day 5)
  • PCR (where available)
  • Antibody detection using ELISA: IgM and IgG

The tourniquet test:

  • Only positive in1/3 of patients
  • Inflate a BP cuff to halfway between systolic and diastolic pressure for 5 mins
  • A positive test shows 20+ petechiae in a 2.5cm square on the forearm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Management for Dengue ?

A

> > No direct human to human transmission so no requirement for isolation.

Non-severe cases:

  • Conservative treatment with oral fluid and paracetamol
  • Avoid aspirin (increased haemorrhage risk)
  • Should also be avoided in children due to risk of Reye’s syndrome

Severe cases (uncommon in returned travellers):

  • IV fluids
  • Regular observation and monitoring of haematocrit, platelets and renal function
  • May require High Dependency or Intensive Care

Deterioration with severe GI haemorrhage:

  • Rare
  • Will require blood transfusion +/- FFP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Pathogen causing genital herpes ?

A

HSV 2 (most common)
HSV1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Clinical features of genital herpes ?

A

Presentation in the first episode:

  • Genital lesions - grouped painful blisters which burst after 2-3 days, resulting in crusted erosions and ulcers on the external genitalia.
  • Painful lesions can also occur on the thigh, buttocks, cervix and rectum.
  • Tingling or burning pain around the genitals
  • Dysuria (in women), which can lead to urinary retention.
  • Urethral or vaginal discharge.
  • Inguinal lymphadenopathy - painful, bilateral enlargement.
  • Systemic illness - headache, fever, myalgia, malaise and constipation.
  • > > Primary episodes can last up to 20 days.

Presentation in recurrent episodes:

  • Prodrome - tingling and burning sensation in the genitals.
  • Genital lesions - usually recur in the same area but lesions less severe than in the initial episode.
  • Lesions crust and heal within 10 days.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Investigations for genital herpes ?

A

PCR:

  • Detection of the virus
  • Most effective if a scraped sample of an ulcer’s base can be taken.
  • Nucleic acid amplification tests (NAAT) are a type of PCR = first-line method of diagnosis in genital herpes.

Viral culture:

  • Most effective if a scraped sample of an ulcer’s base can be taken.
  • If NAAT is not available

Serology:

  • To test for HSV type-specific antibodies (IgG).
  • Should be done in all patients with a new diagnosis of genital herpes (in addition to NAAT or culture).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Management of first episode genital herpes ?

A

Antiviral therapy:

  • Indicated within 5 days of onset of symptoms or while new lesions are still forming.
  • Examples include acyclovir, valaciclovir and famciclovir.

Supportive care:

  • Analgesia: paracetamol, ibuprofen, topical 5% lidocaine ointment
  • Saline bathing
  • Ice packs between the legs
  • Abstain from sexual intercourse until lesions have gone.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Management recurrent episode genital herpes ?

A

> > Self-limiting

Supportive self-care only:

  • Analgesia, saline bathing, ice packs.
  • Abstain from sexual intercourse until lesions have gone.

Episodic antiviral treatment:

  • If attacks are infrequent, and self-care measures are not sufficiently controlling symptoms.

Suppressive antiviral therapy:

  • At least 6 recurrences per year.
  • Duration of therapy is commonly 6 months to 1 year.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Pathogens causing acute epiglottitis ?

A
  • Haemophilus influenzae type B historically the primary pathogen
  • Now Streptococcus pneumoniae, group A streptococci, and Staphylococcus aureus, are more frequently implicated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Clinical features of acute epiglotitis ?

A
  • Severe sore throat and odynophagia - painful swallowing often accompanied by drooling due to difficulty handling secretions.
  • Muffled voice or ‘hot potato’ voice - characteristic change in voice quality due to the swollen epiglottis.
  • Stridor
  • Respiratory distress
  • High-grade fever
  • Tripod or sniffing position
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Investigations for acute epiglotitis?

A

> > Usually clinical diagnosis

Lateral neck radiograph:

  • The ‘thumb sign’ - swollen epiglottis
  • Only be performed if patient is stable, as manipulation of the airway can precipitate complete airway obstruction.

Flexible fiberoptic laryngoscopy:

  • Only if the patient is stable, as it may trigger laryngospasm.

Blood cultures and throat swabs:

  • Can help identify the causative pathogen and guide antibiotic therapy.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Management of acute epiglottitis ?

A
  • Airway management (preferably in ICU) - endotracheal intubation or emergent tracheostomy may be necessary
  • Empiric broad-spectrum antibiotics, such as third-generation cephalosporins
  • Supportive care - IV fluids, analgesics, and antipyretics may be administered as needed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Investigations for Hep A ?

A

Hepatitis serology:

  • First line = PCR test for hepatitis A RNA.
  • If not available = HAV-IgM and HAV-IgG blood tests
  • Positive HAV-IgM and positive HAV-IgG suggests acute hepatitis A infection.
  • Negative HAV-IgM and positive HAV-IgG suggests past hepatitis A infection or immunity.
  • A high IgG reactivity and a moderate level of IgM suggests recent infection rather than acute infection.

LFTs:

  • Significantly raised ALT and AST
  • Bilirubin may be elevated, as well as PT
  • ALP may be elevated but generally less than 2 times upper limit of normal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Management of Hep A ?

A

> > Usually mild and self-limiting and require no specific treatment
Severely unwell patients should be admitted to hospital

Generally symptom management is all that is required

  • Rest and stay hydrated.
  • Pain relief as required, with dose adjustment if liver impairment.
  • Anti-emetics as required, including metoclopramide or cyclizine unless impaired liver function.
  • For itch, use simple measure such as loose clothing and avoiding hot baths and showers and chlorphenamine if required unless impaired liver function.
  • Avoid alcohol.
  • Ensure good personal hygiene practices and avoid food preparation, and sexual intercourse for 7 days after symptom onset.
  • Patients should avoid work or school for 7 days after symptom onset.
  • Patients should be followed-up every 1-2 weeks, and LFTs repeated until amino-transferase levels are within normal levels.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Investigations for Hep B ?

A

LFTs:
ALT + AST

  • Acute viral hepatitis = raised >25 times the upper limit of normal
  • Active chronic HBV = mildly raised (about 2x the upper limit of normal)
  • Acute flares/exacerbations of chronic HBV = raised >10 times the upper limit of normal
  • Chronic HBV carriers = usually normal
  • AST:ALT ratio can be raised

ALP + GGT

  • In HBV infection, the ALT and AST are expected to be raised much further than the ALP and GGT

Hepatitis serology:

  • HBsAg - only positive in current infection (chronic = persistently raised for >6 months)
  • Anti-HBs - previous infection / vaccination
  • Anti-HBc - only present in previous or current infective state (never post-vaccination)
  • IgM is the first antibody made to fight a new infection, therefore will be the predominant antibody in acute HBV
  • IgG is associated with a longer-term reaction and therefore will predominate in chronic HBV
  • It is important to note that IgM anti-HBc may be seen in acute exacerbations of chronic hepatitis B, or up to 2-years after acute HBV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Management acute Hep B ?

A

> > Mainly supportive

Active treatment if:

  • Severe coagulopathy (INR >1.5)
  • Persistent symptoms for >4 weeks
  • Marked jaundice (bilirubin >3mg/dL)
  • Presence of ascites or encephalopathy

Tenofovir or entecavir:

  • Liver transplant considered in all patients with fulminant hepatic failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Management chronic Hep B ?

A

Indications for treatment:

  • Acute liver failure
  • Decompensated cirrhosis
  • Compensated cirrhosis + HBV DNA >2000IU/mL
  • Patients receiving concurrent immunosuppressive therapy
  • Hepatocellular carcinoma

Anti-viral therapy:

  • First-line (no cirrhosis) = entecavir, tenofovir or peginterferon alfa 2a
  • First line (with cirrhosis) = entecavir or tenofovir
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Complications of Hep B ?

A
  • Fulminant liver failure
  • Liver cirrhosis
  • Hepatocellular carcinoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Investigations for Hep C?

A

Before initiating treatment, it’s vital to:

  • Confirm Diagnosis: Through HCV RNA testing
  • Genotype Assessment: Determines the strain of the virus, which influences treatment choice and duration.
  • Liver Disease Staging: Evaluate the degree of liver fibrosis and cirrhosis, which can be done via liver biopsy, elastography, or serum markers.

Co-infections: Screen for HIV and hepatitis B, as they influence management

  • LFTs: Including ALT, AST, bilirubin, and albumin.
  • Assess for Contraindications: To DAAs and potential drug interactions.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Management of Hep C?

A

»Direct-Acting Antivirals (DAAs)

  • Combination of protease inhibitors (e.g. daclatasvir + sofosbuvir or sofosbuvir + simeprevir) with or without ribavirin
  • Duration ranges between 8-12 weeks, but some patients, particularly those with cirrhosis or prior treatment experience, may require extended durations.
  • Monitoring HCV RNA Levels to assess response to therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What should patients be monitored for following Hep A treatment?

A
  • Sustained Virological Response (SVR) - undetectable HCV RNA 12 weeks post-treatment. SVR12 is considered a cure in most cases.
  • Liver Disease - patients with advanced fibrosis or cirrhosis should continue to be monitored for hepatocellular carcinoma and complications of cirrhosis.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Clinical features of HIV?

A
  • sore throat
  • lymphadenopathy
  • malaise, myalgia, arthralgia
  • diarrhoea
  • maculopapular rash
  • mouth ulcers
  • rarely meningoencephalitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Management of HIV?

A

TREAT ALL REGARDLESS OF CD4 COUNT

Highly active anti-retroviral therapy (HAART):

  • Involves a combination of at least three drugs
  • Typically two nucleoside reverse transcriptase inhibitors (NRTI) and either a protease inhibitor (PI) or a non-nucleoside reverse transcriptase inhibitor (NNRTI)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Complications of HIV with CD4 count 200 - 500?

A
  • Oral thrush
  • Shingles
  • Hairy leukoplakia
  • Kaposi sarcoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Complications of HIV with CD4 count 100 - 200?

A
  • Cryptosporidiosis
  • Cerebral toxoplasmosis
  • Progressive multifocal leukoencephalopathy (JCV)
  • PCP
  • HIV dementia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Complications of HIV with CD4 count 50 -100?

A
  • Aspergillosis
  • Oesophageal candidiasis
  • Cryptococcal meningitis
  • Primary CNS lymphoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Complications of HIV with CD4 count <50?

A
  • Cytomegalovirus retinitis
  • Mycobacterium avium-intracellulare infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Features of gonorrhoea?

A
  • males: urethral discharge, dysuria
  • females: cervicitis e.g. leading to vaginal discharge
  • rectal and pharyngeal infection is usually asymptomatic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Management of gonorrhoea?

A
  • First line = single dose of IM ceftriaxone 1g
  • If sensitivities known and organism sensitive to ciprofloxacin - single dose of oral ciprofloxacin 500mg
  • If ceftriaxone is refused (e.g. needle-phobic) - single dose oral cefixime 400mg + oral azithromycin 2g
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Swab findings in gonorrhoeic?

A

Gram neg diplococci

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Disseminated gonococcal infection?

A
  • tenosynovitis
  • migratory polyarthritis
  • dermatitis (lesions can be maculopapular or vesicular)

> > Later complications include septic arthritis, endocarditis and perihepatitis (Fitz-Hugh-Curtis syndrome)

49
Q

Clinical symptoms of acute schistosomiasis?

A
  • Swimmers’ itch
  • Acute schistosomiasis syndrome (Katayama fever) - fever, urticaria/angioedema, arthralgia/myalgia, cough, diarrhoea, eosinophilia
50
Q

RF for schistosomiasis?

A

Freshwater swimming in endemic areas (most commonly Africa)

51
Q

Clinical features of urogenital schistosomiasis?

A

Schistosoma haematobium: Eggs deposit in the bladder

  • local skin hypersensitivity reaction e.g. small, itchy maculopapular lesions
  • classic urogenital symptoms
  • bladder calcification
  • can cause an obstructive uropathy and kidney damage
52
Q

Investigations for schistosomiasis?

A
  • Asymptomatic = serum schistosome antibodies
  • Symptomatic = gold standard is urine or stool microscopy looking for eggs
53
Q

Management of schistosomiasis?

A
  • single oral dose of praziquantel
  • often needs to be repeated after a few weeks as it is more effective when the worms have grown.
  • steroids may be used for symptomatic relief
54
Q

Clinical features of amoebic dysentery?

A
  • profuse, bloody diarrhoea
  • may be a long incubation period
  • stool microscopy may show trophozoites if examined within 15 minutes or kept warm (known as a ‘hot stool’)
55
Q

Management of amoebic dysentery / liver abscess?

A
  • oral metronidazole
  • a ‘luminal agent’ (to eliminate intraluminal cysts) is recommended usually as well e.g. diloxanide furoate
56
Q

Clinical features of amoebic liver abscess?

A
  • usually a single mass in the right lobe (may be multiple)
  • contents are often described as ‘anchovy sauce’
  • fever, RUQ pain, systemic symptoms e.g. malaise, hepatomegaly
  • associated with erythema multiforme
57
Q

Clinical features of mycoplasma pneumoniae?

A

anaemia, raised LDH, raised unconjugated bilirubin → autoimmune haemolytic anaemia

58
Q

Investigations for mycoplasma pneumoniae?

A
  • diagnosis by Mycoplasma serology
  • positive cold agglutination test → peripheral blood smear may show red blood cell agglutination
  • chest X-ray shows bilateral consolidation
59
Q

Management of mycoplasma pneumoniae?

A

doxycycline or a macrolide (e.g. erythromycin/clarithromycin)

60
Q

Clinical features of leprosy?

A
  • patches of hypopigmented skin typically affecting the buttocks, face, and extensor surfaces of limbs
  • sensory loss
61
Q

Describe the classification of leprosy

A

Lepromatous leprosy (‘multibacillary’):

  • extensive skin involvement
  • symmetrical nerve involvement

Tuberculoid leprosy (‘paucibacillary’):

  • limited skin disease
  • asymmetric nerve involvement → hypesthesia
  • hair loss
62
Q

Management of leprosy?

A

triple therapy: rifampicin, dapsone and clofazimine

63
Q

Clinical features of legionella?

A
  • flu-like symptoms including fever (present in > 95% of patients)
  • dry cough
  • relative bradycardia
  • confusion
  • lymphopaenia
  • hyponatraemia
  • deranged liver function tests
  • pleural effusion: seen in around 30% of patients
64
Q

Management of legionella?

A

treat with erythromycin/clarithromycin

65
Q

RFs for leptospirosis?

A
  • sewage workers, farmers, vets or people who work in an abattoir
  • common in the tropics so should be considered in the returning traveller
66
Q

Clinical features of leptospirosis?

A

Early phase is due to bacteraemia and lasts around a week:

  • may be mild or subclinical
  • fever / flu-like symptoms
  • subconjunctival suffusion (redness)/haemorrhage

second immune phase may lead to more severe disease (Weil’s disease)

  • acute kidney injury (seen in 50% of patients)
  • hepatitis: jaundice, hepatomegaly
  • aseptic meningitis
67
Q

Investigations for leptospirosis?

A
  • serology: antibodies to Leptospira develop after about 7 days
  • PCR
  • culture - growth may take several weeks so limits usefulness in diagnosis
  • blood and CSF samples are generally positive for the first 10 days
  • urine cultures become positive during the second week of illness
68
Q

Management of leptospirosis?

A

high-dose benzylpenicillin or doxycycline

69
Q

Diagnosis of HIV?

A
  • combination tests (HIV p24 antigen and HIV antibody) are now standard for the diagnosis and screening of HIV
  • if the combined test is positive it should be repeated to confirm the diagnosis
  • testing for HIV in asymptomatic patients should be done at 4 weeks after possible exposure
  • after an initial negative result when testing for HIV in an asymptomatic patient, offer a repeat test at 12 weeks
70
Q

Chronic Hep B appearance on light microscopy?

A

Ground-glass hepatocytes

71
Q

Management of bacterial meningitis?

A
  • IV access → take bloods and blood cultures
  • Lumbar puncture - if cannot be done within first hour, IV antibiotics should be given after blood cultures have been taken
  • IV antibiotics - cefotaxime/ ceftriaxone (if >50yrs / <3m, + amoxicillin/ampicillin)
  • Consider IV dexamethasone - preferably starting before or with first dose of antibacterial, but no later than 12 hours after starting antibacterial
  • Avoid dexamethasone in septic shock, meningococcal septicaemia, or if immunocompromised, or in meningitis following surgery’
  • CT scan if signs of raised ICPManagem
72
Q

Management of meningitis caused by Listeria?

A

IV amoxicillin (or ampicillin) + gentamicin

73
Q

Management of Meningococcal meningitis?

A

IV benzylpenicillin or cefotaxime (or ceftriaxone)

74
Q

Management of contacts of meningitis?

A

Abx prophylaxis with oral ciprofloxacin (or rifampicin)

75
Q

Management of UTI in a pregnant woman in the third trimester?

A

amoxicillin or cefalexin

76
Q

Most common infective cause of diarrhoea in patients with HIV?

A

Cryptosporidium parvum

77
Q

Diagnosis of cryptosporidium?

A

stool: modified Ziehl-Neelsen stain (acid-fast stain) of the stool may reveal the characteristic red cysts of Cryptosporidium

78
Q

Common cause of pneumonia after influenza infection?

A

Staph aureus

79
Q

HIV PEP?

A
  • Combination of oral antiretrovirals for 4 weeks
  • Can be administered up to 72 hours post-exposure
80
Q

Vaccines offered for chronic hep?

A
  • annual influenza vaccine
  • one-off pneumococcal vaccine
81
Q

Lyme disease?

A

Caused by the spirochaete Borrelia burgdorferi and is spread by ticks

82
Q

Early clinical features of Lyme disease?

A

Erythema migrans:

  • ‘bulls-eye’ rash is typically at the site of the tick bite
  • typically 1-4 weeks after initial bite but may present sooner
  • usually painless, more than 5 cm in diameter and slowly increases in size

systemic features:

  • headache
  • lethargy
  • fever
  • arthralgia
83
Q

Late clinical features of Lyme disease?

A
  • cardiovascular - heart block, peri/myocarditis
  • neurological - facial nerve palsy, radicular pain, meningitis
84
Q

Investigations for Lyme disease?

A

> > Diagnosed clinically if erythema migrans is present

First line = ELISA antibodies to Borrelia burgdorferi:

  • if negative and Lyme disease still suspected in people tested within 4 weeks from symptom onset, repeat the ELISA 4-6 weeks after the first ELISA test.
  • If still suspected in people who have had symptoms for 12 weeks or more then an immunoblot test should be done
  • if positive or equivocal then an immunoblot test should be done
85
Q

Management of asymptomatic tick bites?

A
  • If the tick is still present, the best way to remove it is using fine-tipped tweezers, grasping the tick as close to the skin as possible and pulling upwards firmly
  • The area should be washed following.
  • NICE guidance does not recommend routine antibiotic treatment to patients who’ve suffered a tick bite
86
Q

Management of suspected / confirmed Lyme disease?

A
  • Doxycycline if early disease
  • Amoxicillin if contraindicated (e.g. pregnancy)
  • People with erythema migrans should be commenced on antibiotic without the need for further tests
  • Ceftriaxone if disseminated disease
  • Jarisch-Herxheimer reaction is sometimes seen after initiating therapy: fever, rash, tachycardia after first dose of antibiotic (more commonly seen in syphilis, another spirochaetal disease)
87
Q

Clinical features of infectious mononucleosis?

A

Classic triad:

  • sore throat
  • lymphadenopathy
  • pyrexia

Also:

  • malaise, anorexia, headache
  • palatal petechiae
  • splenomegaly
  • hepatitis, transient rise in ALT
  • lymphocytosis: presence of 50% lymphocytes with at least 10% atypical lymphocytes
  • haemolytic anaemia secondary to cold agglutins (IgM)
  • maculopapular, pruritic rash develops following ampicillin/amoxicillin
88
Q

Diagnosis of infectious mononucleosis?

A
  • Heterophil antibody test (Monospot test)
  • FBC and Monospot in the 2nd week of the illness to confirm a diagnosis of glandular fever.
89
Q

Management of infectious mononucleosis?

A
  • rest during the early stages, drink plenty of fluid, avoid alcohol
  • simple analgesia for any aches or pains
  • avoid playing contact sports for 4 weeks after having glandular fever to reduce the risk of splenic rupture
90
Q

Commonest cause of bacterial infectious intestinal disease?

A

Campylobacter

91
Q

Features of campylobacter?

A
  • prodrome: headache malaise
  • diarrhoea: often bloody
  • abdominal pain: may mimic appendicitis
92
Q

Management of campylobacter?

A
  • usually self-limiting
  • treatment if severe or patient is immunocompromised
  • antibiotics if severe symptoms (high fever, bloody diarrhoea, or >8 stools/d) or symptoms have last >1w
  • first-line antibiotic is clarithromycin
  • ciprofloxacin is an alternative
93
Q

Complications of campylobacter?

A
  • GBS
  • reactive arthritis
  • septicaemia, endocarditis, arthritis
94
Q

Toxoplasmosis?

A
  • most common neurological infection seen in HIV
  • constitutional symptoms, headache, confusion, drowsiness
  • CT: usually single or multiple ring enhancing lesions, mass effect may be seen
  • management: sulfadiazine and pyrimethamine
95
Q

When to give tetanus vaccine?

A

Patient has had a full course of tetanus vaccines, with the last dose < 10 years ago:

  • no vaccine nor tetanus immunoglobulin is required, regardless of the wound severity

Patient has had a full course of tetanus vaccines, with the last dose > 10 years ago:

  • if tetanus prone wound: reinforcing dose of vaccine
  • high-risk wounds (e.g. compound fractures, delayed surgical intervention, significant degree of devitalised tissue): reinforcing dose of vaccine + tetanus immunoglobulin

If vaccination history is incomplete or unknown:

  • reinforcing dose of vaccine, regardless of the wound severity
  • for tetanus prone and high-risk wounds: reinforcing dose of vaccine + tetanus immunoglobulin
96
Q

Features of severe malaria?

A
  • schizonts on a blood film
  • parasitaemia > 2%
  • hypoglycaemia
  • acidosis
  • temperature > 39 °C
  • severe anaemia
97
Q

Management of uncomplicated falciparum malaria?

A

artemisinin-based combination therapies (ACTs)

98
Q

Management of severe falciparum malaria?

A
  • intravenous artesunate
  • if parasite count > 10% then exchange transfusion should be considered
99
Q

Clinical features of malaria?

A

fever, hepatosplenomegaly, diarrhoea and jaundice

100
Q

Management of shigellosis?

A

> > Usually managed in primary care, as disease is generally mild and self-limiting

  • Rehydration
  • Antibiotic therapy if - malnourished, immunocompromised, elderly, food handlers, healthcare workers, severe disease (bloody diarrhoea with cramping while systemically unwell)
  • ciprofloxacin
101
Q

Clinical features of syphilis?

A

Early syphilis is defined as the first 2 years after infection and includes 3 stages:

(1) Primary syphilis:

  • Painless chancre - highly infectious, hard anogenital ulcer
  • Local lymphadenopathy

(2) Secondary syphilis:

  • Symmetrical maculopapular rash, typically on the trunk, face, palms or soles, might be scaly
  • Constitutional symptoms - fever, malaise, myalgia, fatigue, and arthralgia
  • Lymphadenopathy
  • Tonsillitis
  • Condylomata lata (flat papules around/ beyond the genitals)
  • Oral snail-track ulcers
  • Also - Alopecia, Hepatitis, Hepatosplenomegaly, Rhinitis, Uveitis, Optic neuritis, Meningism, Glomerulonephritis, Periosteitis

(3) Early latent syphilis:Confirmed infection in the absence of any current clinical features.

  • If untreated, might progress to tertiary or late syphilis (defined as more than 2 years after infection).
  • In the late stage, the disease may damage the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints
102
Q

Diagnosis of syphilis?

A
  • Positive serological treponeme specific antibody testing (which will remain positive for life)
  • Positive non-treponeme specific antibody testing (to confirm active infection).
103
Q

Management of syphilis?

A

If diagnosis is confirmed:

  • Benzathine benzylpenicillin IM 2-3 doses, 1 week apart
  • Alternative: Doxycycline 100mg/12h (14 days for early syphilis, 28 days for late syphilis)
  • In pregnancy: Erythromycin 500mg/6h PO

> > Follow up at 3, 6, and 12 months in specialist GUM clinic

104
Q

When should HIV patient receive PCP prophylaxis?

A

all patients with a CD4 count < 200/mm³

105
Q

Management of PCP?

A

Co-trimoxazole
IV pentamidine in severe cases

106
Q

Tests prior to starting TB treatment?

A

U&Es, LFTs, vision testing, FBC

107
Q

Cause of black hairy tongue?

A

Tetracyclines

108
Q

Clinical features of anthrax?

A
  • causes painless black eschar (cutaneous ‘malignant pustule’, but no pus)
  • typically painless and non-tender
  • may cause marked oedema
  • anthrax can cause gastrointestinal bleeding
109
Q

Management of anthrax?

A

ciprofloxacin

110
Q

Aspergilloma on CXR?

A
  • rounded opacity
  • crescent sign may be present
111
Q

Cat scratch disease?

A

Bartonella henselae

112
Q

Investigations for chlamydia?

A

NAATs are investigation of choice:

  • women: vulvovaginal swab is first-line
  • men: urine (first void urine sample) is first-line
  • should be carried out two weeks after a possible exposure
113
Q

Management of chlamydia?

A
  • doxycycline (7 day course) if first-line
  • if contraindicated / not tolerated then azithromycin (1g od for one day, then 500mg od for two days)
  • if pregnant then azithromycin, erythromycin or amoxicillin

partner notification:

  • for men with urethral symptoms: all contacts since, and in the four weeks prior to, the onset of symptoms
  • for women and asymptomatic men all partners from the last six months or the most recent sexual partner should be contacted
114
Q

Clinical features of cholera?

A

profuse ‘rice water’ diarrhoea
dehydration
hypoglycaemia

115
Q

management of cholera?

A

oral rehydration therapy
antibiotics: doxycycline, ciprofloxacin

116
Q

clinical features of tetanus?

A

prodrome fever, lethargy, headache
trismus (lockjaw)
risus sardonicus: facial spasms
opisthotonus (arched back, hyperextended neck)
spasms (e.g. dysphagia)

117
Q

Most common cause of non-bloody travellers diarrhoea?

A

E coli

118
Q
A

YEAR 6 (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions