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Infection > MedEd > Flashcards

MedEd Flashcards

1
Q

what sort of virus is HIV

A

retrovirus (+sense RNA)

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2
Q

which continent has a high prevalence of HIV

A

africa

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3
Q

what is the life cycle of HIV

A

1 Attachment/Entry
2 Reverse Transcription of RNA and DNA Synthesis
3 Integration
4 Viral Transcription & Viral Protein Synthesis
5 Assembly & Release of Virus
6 Maturation
→ Reduction in CD4 cell count

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4
Q

how can HIV be transmitted

A 
sexual contact
pregnancy, childbirth, breastfeeding
IVDU
occupational exposure
blood tranfusion or organ transplant
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5
Q

how is HIV not transmitted

A

air/water
insects or pets
faecal-oral route

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6
Q

what are the three stages of HIV

A

1 primary infection
2 asymptomatic phase
3 AIDS

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7
Q

what are features of primary infection in HIV

A

transient illness of 2-6wks post exposure
non-specific symptoms such as fever, fatigue, malaise
maculopapular rash
lymphadenopathy

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8
Q

what are features of the asymptomatic phase in HIV

A

persistent generalised lymphadenopathy
constitutional symptoms
CD4<400 (mild immunosuppression)

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9
Q

what are constitutional symptoms of HIV

A

fever, night sweats, diarrhoea, weight losss

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10
Q

what defines AIDS

A

CD4 <200

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11
Q

what are features of AIDS in HIV

A 
CD4<200
opportunistic infections (oral candida, herpes zoster, tinea
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12
Q

how long does it take for HIV infection to progress to AIDS

A

8-10yrs

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13
Q

what commonly is a precipitant to HIV

A

unprotected sex
Eye
-CMV retinitis - mozerella pizza sign

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14
Q

what are CNS signs + infections in HIV

A
  • HAND - subcortical dementia
  • encephalopathy
  • toxoplasma gondii
  • cryptococcal meningitis
  • CMV encephalitis
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15
Q

what are eye signs + infections in HIV

A

CMV retinitis - mozzeralla pizza sign

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16
Q

what are features of subcortical dementia of HIV

A

motor slowing and loss of executive control

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17
Q

what are pulmonary infections in HIV

A 
TB
mycobacterium
CMV pneumonitis
pneumocystis jiroveci pneumonia
aspergillus, cryptococcus histoplasma
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18
Q

what are tumours associated with HIV

A

lymphomas
kaposis sarcoma
SCC

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19
Q

what gut signs + infections in HIV

A 
anorexia, weight loss, HIV, enteropathy
oral pain due to candidiasis
EBV - oral hairy leucoplakia
CMV oesophagitis, CMV colitis
HSV ulcers
Chronic diarrhoea
Perianal disease, recurrent HSV uiceration, perianal warts
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20
Q

what investigations are completed in suspected HIV

A

CD4 count
HIV RNA
HIV antibodies

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21
Q
  1. A 27 year old IVDU complains of increasing shortness of breath that has been getting worse over the last three weeks accompanied by a dry cough. Her saturations are 94% and drop to 87% when walking. Her CD4 count is 150. CXR showed non-specific reticular interstitial shadowing.
Pneumocystis Jiroveci 
Haemophilus Influenzae
Streptococcus Pneumoniae
Mycobacterium Tuberculosis
Cytomegalovirus
A

Pneumocystis Jiroveci

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22
Q
  1. A 36 year old man who has sex with men comes to the GP with ulceration, bleeding and discomfort around his anus. He is trying alternative therapies to treat his HIV.
Cytomegalovirus
Human Papillomavirus
Human Herpes Virus 8
Herpes Simplex Virus
Epstein-Barr Virus
A

Human Papillomavirus

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23
Q
  1. A 31 year old lady on the HIV ward has white gunk all over her tongue that extends into her throat which can be peeled off. She says it’s very painful to swallow.
Candida albicans
Epstein-Barr virus
Herpes Simplex Virus
Streptococcal throat infection
Human herpes Virus 8
A

Candida albicans

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24
Q
  1. A 43 year old HIV positive patient presents with weakness of his right leg, headaches, fever and confusion that have been getting worse for the last week. CT head shows multiple ring-enhancing lesions.
Plasmodium falciparum 
Neisseria meningitidis
Toxoplasma gondii
Herpes Simplex Encephalitis
Pox virus
A

Toxoplasma gondii

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25
Q
  1. A 47-year-old homeless man presents who is HIV-positive presents with purple popular lesions on his back and on his gums.
HHV-2
HHV-4
HHV-5
HHV-7
HHV-8
A

HHV-8

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26
Q

what is pneumocystis jiroveci

A

a yeast like fungus

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27
Q

what does pneumocystis jiroveci cause and in who

A

pneumonia in immunocompromised

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28
Q

what are features of pneumocystis jiroveci

A

fever
dry cough + exertional SOB
reduced O2 sats
bilateral crepitations

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29
Q

what is seen on CXR with pneumocystis jiroveci

A

bilateral perihilar interstitial shadowing

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30
Q

what is seen on CT chest with pneumocystis jiroveci

A

ground glass opacification

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31
Q

how is pneumocystis jiroveci diagnosed

A

sputum (to visualise organism)

bronchoalveolar lavage

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32
Q

what is used to treat pneumocystis jiroveci

A

co-trimoxazole

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33
Q

how is HPV spread

A

sexual contact

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34
Q

what does HPV cause

A

genital warts

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35
Q

what types of HPV are associated with cervical cancer in women and anal cancer in men

A

16 & 18

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36
Q

what are features of HPV

A

bleeding, pain, change in bowel habit, itchy bum hole

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37
Q

what is used to treat HPV

A

chemo + radio
or
anorectal excision and colostomy

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38
Q

who is candida albicans common in

A

immunocompromised

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39
Q

what does candida allbicans cause

A 
oral candidiasis
pneumonia
infective endocarditis
vaginal candidiasis (thrush)
urethritis
systemic candidiasis + sepsis
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40
Q

what features does oral candidiasis present with

A

pain on swallowing

dysphagia

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41
Q

what is the treatment for oral condidiasis

A

nystatin suspension

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42
Q

what are features of vaginal candidiasis

A

discharge
red vagina
tenderness

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43
Q

what is the treatment for oral candidiasis

A

clotrimazole vaginal pessary

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44
Q

what is the treatment for systemic candidiasis + sepsis

A

flucanozole

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45
Q

what parts of the body does protozoa toxoplasma gondii affect

A

gut and then migrates to any part of body

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46
Q

how is toxoplasmosis transmitted

A

CATS
poorly cooked meat
soil contaminated vegetables
broken skin

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47
Q

what may reactivate toxoplasmosis

A

HIV

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48
Q

what are features of toxoplasmosis in immunocompromised patients

A 
myocarditis
encephalitis
focal CNS signs
strokes
seizures
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49
Q

what tests are used for toxoplasmosis

A

high IgM in acute

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50
Q

what is the characteristic feature of toxoplasmosis on CT head

A

ring shaped contrast enhancing lesions

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51
Q

what causes kaposis sarcoma

A

HHV-8

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52
Q

what is kaposis sarcoma derived from

A

capillary endothelial cells or fibrous tissue

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53
Q

how does kaposis sarcoma (HHV8) present

A

papules or plaques on the skin and mucosa

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54
Q

how is HHV8 treated

A

optimise HAART
cryotherapy
chemo + radio

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55
Q

A 26 year old lawyer presents with a history of sharp tingling his lips followed by a painful ulcer at the side of his mouth. On examination he has cervical lymphadenopathy and a blister on his finger. What is the pathogen?

Varicella Zoster Virus
Epstein Barr Virus
Herpes Simplex Virus 1
Herpes Simplex Virus 2
Cytomegalovirus
A

Herpes Simplex Virus 1

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56
Q

What is the treatment HSV1

Rest at home, no treatment
Amoxicillin
Acyclovir
Ceftriaxone
Vancomycin
A

Acyclovir

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57
Q

A 19 year old university student present with a sore throat, headache, myalgia and coryzal symptoms. On examination he has cervical lymphadenopathy, enlarged exudative tonsils and splenomegaly. What is the most likely pathogen?

Varicella Zoster Virus
Epstein Barr Virus
Herpes Simplex Virus 1
Herpes Simplex Virus 2
Cytomegalovirus
A

Epstein Barr Virus

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58
Q

What is the treatment for EBV

Rest at home, no treatment
Amoxicillin
Acyclovir
Ceftriaxone
Vancomycin
A

Rest at home, no treatment

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59
Q

what are HHV1 and HHV2 AKA

A

HSV1 and HSV2

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60
Q

what are cardinal features of HSV1 and HSV2

A

HSV1 - oral ulcers, encephalitis

HSV2 - genital ulcers

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61
Q

what is HHV3 AKA

A

VZV

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62
Q

what does VSV cause

A

chicken pox or shingles

63
Q

what is HHV4 AKA

A

EBV (infectious mononucleosis, lymphoma)

64
Q

what is HHV5 AKA

A

CMV

65
Q

what does CMV and EBV cause

A

mononucleosis, hepatitis

66
Q

what is HHV8 associated with

A

kaposis sarcoma

67
Q

aetiology of HSV

A

virus becomes dormant following primary infection

reactivation may occur with physical or emotional stress or when immunocompromised

68
Q

where does HSV lay dormant

A

trigeminal or sacral root ganglia

69
Q

how does HSV present

A 
with recurrent infection or reactivation there is a prodrome of oral tingling and burning
vesicles appear (48hrs), ulcerate and crust over, complete healing in 10days
70
Q

how does HSV1 present

A

Gingivostomatitis (inflammation or ulcers of gums and corners of the mouth)
herpetic whitlow - vesicle in finger
eczema herpeticum - HSV infection on eczematous skin

71
Q

how does systemic infection by HSV1 present

A

fever, sore throat, lymphadenopathy, pneumonitis, hepatitis

72
Q

how does herpes simplex encephalitis by HSV1 present

A

fever, fits, headaches, odd behaviour, dysphasia, hemiparesis

73
Q

how does HSV2 present

A

genital herpes

74
Q

what sort of lymphadenopathy is seen in HSV1

A

tender cervical lymphadenopathy

75
Q

what sort of lymphadenopathy is seen in HSV2

A

inguinal lymphadenopathy

76
Q

how is EBV spread

A

saliva or droplet (inhalation)

77
Q

aetiology of EBV

A

predilection for B lymphocytes, incorporation of viral DNA into host DNA

78
Q

how does EBV present

A

non specific symptoms such as fever, fatigue, malaise

sore throat,

79
Q

what is seen on examination of EBV - infectious mononucleosis

A

inflamed tonsils with exudates
cervical lymphadenopathy
splenomegaly, hepatomegaly (jaundice)

80
Q

how is EBV (infectious mononucleosis) diagnosed

A

monospot test for heterophile antibodies

throat swab

81
Q

when does IgG against EBNA present

A

6-12wks post onset of symptoms

82
Q

What serological profile would you expect to see in a chronic Hepatitis B carrier?

1 HBsAg –, anti-HBc +, anti-HBs +, IgM anti-HBc –
2 HBsAg +, anti-HBc +, anti-HBs –, IgM anti-HBc +
3 HBsAg –, anti-HBc –, anti-HBs –
4 HBsAg +, anti-HBc +, anti-
HBs –, IgM anti-HBc –
5 HBsAg –, anti-HBc –, anti-HBs +

A

4 HBsAg +, anti-HBc +, anti-

HBs –, IgM anti-HBc –

83
Q

what is raised in acute infection (serology)

A 
HBsAg (antigen)
IgM antiHBc (acute)
84
Q

what increases overtime with infection (serology)

A

total anti-HBc

85
Q

what is raised in chronic infection (serology)

A

anti-HBs

86
Q

what is raised long term in chronic infection (serology)

A

HbsAg (antigen)

total anti-HBc

87
Q

what is HbsAg found in

A

acute or chonic INFECTION

88
Q

what is anti-HBs found in

A

recovery + immunity to HBs or successful vaccination

89
Q

what is total anti-HBc found in

A

previous or ongoing infection

90
Q

what is IgM anti-HBc found in

A

acute infection

91
Q

what does HBsAg –, anti-HBc +, anti-HBs +, IgM anti-HBc – indicate

A

previous infection, immune

92
Q

what does HBsAg +, anti-HBc +, anti-HBs –, IgM anti-HBc + indicate

A

acute infection

93
Q

what does HBsAg –, anti-HBc –, anti-HBs – indicate

A

susceptible

94
Q

what does HBsAg +, anti-HBc +, anti-HBs –, IgM anti-HBc – indicate

A

chronic infection

95
Q

what does HBsAg –, anti-HBc –, anti-HBs + indicate

A

vaccinated

96
Q

An 70 year old man has been in hospital for the past two weeks for a severe pneumonia. He develops bloody diarrhoea, colitis, and a reduced urine output. He has a raised CRP, WCC and a low albumin.

Campylobacter
C. difficile 
Bacillus cereus
E. coli
Vibrio cholera
A

C. difficile

97
Q

An 18 year old girl on her gap year comes back from her travels, presenting to hospital with profuse diarrhoea of rice water appearance. There is no blood. She is shocked.

Entamoeba histolytica 
Staph aureus
Bacillus cereus
E. coli
Vibrio cholera
A

Vibrio cholera

98
Q

A man presents suffering with bloody, foul smelling diarrhoea. He attended a barbeque earlier in the day where he suspects he ate undercooked chicken. He has a fever and severe abdominal pain.

Campylobacter
Shigella
Bacillus cereus
E. coli
Salmonella
A

Campylobacter

99
Q

what causes diarrhoea

A 
s aureus
vibrio cholera
e coli
bacilus cereus
campylobacter
c difficile
salmonella
100
Q

what is the mneumonic for causes of dysentry

A

CHESS

Campylobacter ? C difficile
Haemorrhagic e coli
Entamoeba histolytica
Shigella
Salmonella
101
Q

what can cause diarrhoea and dysentry

A

campylobacter
c difficile
salmonella

102
Q

what are buzzwords for c diff infection

A

antibiotic use

103
Q

what are buzzwords for s aureus infection

A

1-6hrs after eating

lasts less than 12hrs

104
Q

what are buzzwords for vibrio cholera infection

A

rice water diarrhoea

poor sanitation

105
Q

what are buzzwords for e coli

A

travellers diarrhoea

leafy vegetables

106
Q

what are buzzwords for b cereus

A

reheated rice

107
Q

what can b cereus cause

A

cerebral abscess

108
Q

what might cause salmonella

A

eggs, poultry

109
Q

what causes campylobacter infection

A

uncooked poultry

110
Q

what causes haemorrhagic e coli

A

leafy vegetables

111
Q

what is haemorrhagic e coli (dysentry) followed by HUS called

A

EHEC (enterohemorrhagic Escherichia coli)

112
Q

what is associated with entamoeba histolytica

A

poor sanitation

tropical places

113
Q

what is associated with shigella

A

person to person cont-cat

114
Q

what is the management for infection causing no systemic signs

A

supportive therapy

no stool culture needed

115
Q

what is the management for systemic illness (>39C or dehydration, visible blood, or lasting >2wks)

A

admit and give oral gluids

direct faecal smear, then culture

116
Q

what management should be taken with infection associated with travel, recent Abx, rectal intercourse or raw seafood

A

culture & microscopy

117
Q

what is indicated if polymorphs are seen on smear

A

campylobacter
e coli
shigella

118
Q

what is indicated if no polymorphs are seen on smear

A

salmonella
e coli
c difficile

119
Q

what organism can present with polymorphs or no polymorphs

A

e coli

120
Q

what is indicated if parasites are found on smear

A

roundworms
tapeworms
flukes (schistosomiasis)

121
Q

The same 18 year old gap year student with resolved diarrhoea has gone back to do more travelling. About a month later, she presents with high swinging fevers and general malaise. You suspect malaria. Which of the following would be your most useful investigation for diagnosis.

FBC
U&amp;Es
ESR/CRP
ABG
Thick and thin blood film
A

Thick and thin blood film

122
Q

A 5 year old child comes home from nursery complaining of feeling like she needs to throw up, and isn’t hungry. A couple of days later a rash develops on her trunk, palms and soles of her feet, which is extremely itchy. What is the most likely causative organism?

Herpes virus 1
Herpes virus 2
Herpes virus 3
Herpes virus 4
Herpes virus 5
A

Herpes virus 3

123
Q

A 70 year old man presents developing a rash across one side of his trunk which is painful and tingling, preceded by a headache and a fever. He had the chickenpox as a child. What is the most likely diagnosis.

Second episode of chickenpox
Herpes simplex virus infection
Shingles
Contact dermatitis 
Fungal infection
A

shingles

124
Q

how does influenza present

A

2-3days post exposure

non-specific symptoms such as fever, fatigue, malaise

sore throat, headache, unproductive cough

125
Q

how is influenza diagnosed

A

based on clinical features + history

126
Q

what are DDx for influenza

A

common cold
streptococcal pharyngitis
meningitis

127
Q

how is influenza managed

A

supportive

or antivirals (oseltamivir) IF
>65yrs
pregnant
diabetes
immunosuppressed
128
Q

what causes malaria

A

plasmodium protozoa

129
Q

what transmits malaria

A

female anopheles mosquitos

130
Q

what is protective against malaria

A

G6PD

sickle cell trait

131
Q

how does malaria present

A 
1 cold stage <1hr
-shivering
2 hot stage (2-6hrs)
-41 degrees, N+V
3 sweats
-as temperature falls
132
Q

what are signs of falciparum malaria infection

A

anaemia, jaundice, hepatosplenomegaly

no rash, lymphadenopathy

133
Q

what are complications of falciparum malaria infection

A

anaemia + thrombocytopenia

134
Q

how is malaria diagnosed

A

thin and thick blood films

135
Q

what does thin blood film look for

A

differentiates types of parasites

136
Q

what does thick blood film look for

A

parasites in the blood

137
Q

how is malaria treated

A

chloroquinine

138
Q

what is HHV3

A

VSV

139
Q

what does VZV cause

A

chickenpox

shingles

140
Q

what is chickenpox

A

a contagious febrile illness characterised by crops of blisters at various stages

141
Q

how long is chickenpoxs incubation period

A

11-21days until signs or symptoms

142
Q

how long is chickenpox infectious for

A

4 days BEFORE rash UNTIL all lesions have scabbed over

143
Q

what does VZV lay dormant after infection

A

in trigeminal or sacral dorsal root ganglia

144
Q

how does chickenpox present

A

prodrome of fatigue, fever, nausea, anorexia
OE
-fever
-rash (small erythematous macules which progress to papules and then develop crusts)

145
Q

who is chickenpox common in

A

children

146
Q

how do adults present with chickenpox

A

a more prolonged fever and a more widespread rash

147
Q

how is a diagnosis of chickenpox or shingles made

A

clinical history + examination

148
Q

what is the management of chickenpox in a healthy child

A

symptomatic and supportive treatment

149
Q

what is the management for chickenpox or shingles in a adolescent or immunocompetent adult

A

oral aciclovir

150
Q

what is the management for chickenpox or shingles with complications

A

admit to hospital

IV aciclovir

151
Q

what complications are associated with chickenpox

A

DIC
pneumoitis
ataxia

152
Q

what is shingles

A

reactivation of VSV which was dormant in dorsal root ganglia

153
Q

how does shingles present

A

prodrome of abnormal sensation + pain in dermatomal distribution
then a unilateral rash, with vesicular lesions which crust over in a week and heal in 3 weeks

154
Q

what is neuritis

A

neuralgic pain over the same area

associated with shingles

Infection (11 decks)

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