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MCCQE1 > Medicine- Infectious Diseases > Flashcards

Medicine- Infectious Diseases Flashcards

1
Q

Sepsis definition

A

Severe organ dysfunction resulting from dysregulated host response to infection

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2
Q

Sofa score for sepsis- criteria

A
  1. Resp rate >22 2. Systolic BP <100mmHg 3. Altered mentation (GCS<15)
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3
Q

Pathophysiology of sepsis

A

Bacteremia - local immune response - pro-inflammatory cytokine release - spread of immune response beyond local environment - unregulated, exaggerated systemic immune response - vasodilation and hypotension - distributive shock and reduced O2 delivery to tissues - anaerobic metabolism and lactic acid production - metabolic acidosis - multiple organ failure

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4
Q

Erythema migrans + cranial nerve lesion, name the likely infection

A

Lyme Disease

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5
Q

Cat scratch disease organism

A

Bartonella henselae

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6
Q

Rocky Mountain Spotted Fever- organism and treatment

A

Rickettsia rickettsii Rx Doxycycline

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7
Q

Rocky Mountain Spotted Fever Investigations

A

Skin biopsy and serology (indirect fluorescent antibody test)

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8
Q

Rocky Mountain Spotted Fever vector

A

Ticks (Dermancentor)

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9
Q

Features of secondary syphilis (3)

A
  1. Maculo-papular non-pruritic rash including palms and soles
  2. Generalized lymphadenopathy, low grade fever, malaise, headache, aseptic meningitis, ocular/otic syphilis
  3. Condylomata lata: painless, wart-like lesion on palate, vulva, or scrotum (highly infectious)
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10
Q

Confirmatory investigations for syphilis

A
  1. TPI (T pallidum immobilization assay)
  2. FTA-ABS (fluorescent treponema antibody absorption)
  3. Darkfield microscopy with silver stain (Warthin-starry stain)
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11
Q

Diagnosis of Lyme disease

A

by enzyme linked immunosorbent assay for Borrelia burgdorferi

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12
Q

TB risk factors

A
  • Immunocompromised/ (especially HIV, including extremes of age)
  • Immunosuppressed (TNF inhibitors, glucocorticoids)
  • Silicosis
  • Chronic kidney disease requiring dialysis
  • Diabetes
  • Malignancy and chemotherapy
  • Substance use (e.g. drug use, alcoholism, smoking)
  • At risk pop- indigenous, E European
  • Crowded accommodation IVDU Homeless
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13
Q

Classic triad on CXR of active TB

A

apical-posterior infiltrates

lung volume loss

cavitation

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14
Q

TB Rx

A

TB Treatment RIPE Rifampin, INH, Pyrazinamide, Ethambutol

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15
Q

Viral load in HIV is a measurement of what?

A

HIV RNA

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16
Q

What is the confirmatory test for HIV?

A

Western blot confirmation by detection of antibodies to at least two different HIV protein bands (p24, gp41, gp120/160); specificity >99.99%

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17
Q

Initial screening test for HIV

A

Enzyme linked immunosorbent assay (ELISA) detects serum antibody to HIV; sensitivity >99.5%

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18
Q

Pneumocystis jiroveci treatment first line

A

TMP/SMX Trimethoprim + sulfamethoxazole

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19
Q

Pneumocystis jiroveci classic X-Ray findings

A

Interstitial pneumonia

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20
Q

The leading cause of meningitis in patients with HIV

A

Crypotoccus sp

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21
Q

Rx of cryptococcus in HIV+ men

A

Amphotericin B (+ flucytosine) is used in the first 2 wk for induction therapy; limited duration dt SFX Switch to fluconazole for at least 8 wk as consolidation therapy, then continue at lower dose for prolonged maintenance

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22
Q

Rx invasive aspergillosis

A

Voriconazole or amphotericin B

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23
Q

Leprosy Rx

A

Dapsone & rifampicin

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24
Q

Clostridium tetani- type of organism

A

motile, spore forming, anaerobic Gram-positive bacillus

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25
Q

The action of tetanus toxin

A

Toxin travels via retrograde axonal transport to the CNS where it irreversibly binds presynaptic neurons to prevent release of inhibitory neurotransmitters (e.g. GABA) Results in disinhibition of spinal motor reflexes which results in tetany and autonomic hyperactivity

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26
Q

Diagnosis of tetanus

A

Clinical CK may be elevated

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27
Q

Management of tetanus

A

Stop toxin production

Wound debridement to clear necrotic tissue and spores

Antimicrobial therapy: IV metronidazole; IV penicillin G is an alternative

Neutralize unbound toxin with tetanus immune globulin (TIg)

Supportive therapy: intubation, spasmolytic medications (benzodiazepines), quiet environment, cooling blanket Control autonomic dysfunction: - and -blockade (e.g. labetalol), magnesium sulfate

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28
Q

Empiric therapy for bacterial meningitis >3months of age

A

age >3 mo: ceftriaxone + vancomycin

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29
Q

Most commonly affected valve in infective endocarditis

A

MV

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30
Q

Minor Duke criteria for infective endocarditis

A
  1. Predisposing condition (abnormal heart valve, IVDU)
  2. Fever (38.0°C/100.4°F)
  3. Vascular phenomena: major arterial emboli, septic pulmonary infarcts, mycotic aneurysms, ICH, conjunctival hemorrhages, Janeway lesions
  4. Immunologic phenomena: glomerulonephritis, rheumatoid factor, Osler’s nodes, Roth’s spots
  5. Positive blood culture but not meeting major criteria OR serologic evidence of active infection with organism consistent with IE
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31
Q

Modified Duke Criteria- number for a definite Dx of Infective Endocarditis

A

2 major OR 1 major + 3 minor OR 5 minor

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32
Q

The organism responsible for most cases of non-gonococcal arthritis in adults

A

staph aureus

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33
Q

Characteristics of infected synovial fluid

A

opaque, increased WBCs (>15,000/mm3: likelihood of infection increases with increasing WBCs), PMNs >90%, culture positive

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34
Q

Most common cause of cellulitis

A

Beta-hemolytic streptococci

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35
Q

Diagnosis of necrotising fasciitis

A

Clinical

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36
Q

Typical cause of monomicrobial infection in necrotising fasciitis

A

Group A Strep

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37
Q

Blind Rx of necrotising fasciitis

A

meropenem or piperacillin/ tazobactam + clindamycin IV

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38
Q

Influenza incubation period

A

incubation period 1-4 d

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39
Q

Gold standard diagnostic test for influenza

A

nasopharyngeal swabs for RT-PCR (gold standard)

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40
Q

For whom is influenza vaccine indicated?

A

Vaccine for influenza A and B viruses is recommended annually for all ages 6 mo (according to TN)

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41
Q

Clinical evidence of consolidation

A

dullness to percussion, bronchial breath sounds, crackles

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42
Q

Airborne infections

A

M. tuberculosis, disseminated VZV, measles

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43
Q

Things you can’t see on a gram stain

A

Mycobacteria Ricketsii Chlamydia Mycoplasma Treponema

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44
Q

Anaerobic gram positive rods

A

Clostridium sp C. difficile C. tetani C. botulinum C. perfringens

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45
Q

Aerobic gram negative cocci

A

Neisseria N. meningiditis N. gonorrhoeae Moraxella M. catarrhalis

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46
Q

Shigella- describe the organism

A

Aerobic gram negative rod

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47
Q

Listeria- describe the organism

A

Aerobic gram positive rod

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48
Q

Campylobacter-describe the organism

A

Aerobic gram negative rod

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49
Q

What is a typical source of vibrio vulnificus septicaemia?

A

Eating raw oysters

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50
Q

First line treatment for anogenital warts (HPV)

A

Podophyllotoxin 5% solution

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51
Q

TOC for dental abscess

A

Clindamycin, or amoxycillin/ clavulanate

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52
Q

Management of infectious tenosynovitis

A

Surgery and IV Abx

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53
Q

What does positive Hep B surface antigen imply?

A

That the individual is infectious

54
Q

What does the presence of hep B surface antibody imply?

A

That the individual is immune, either through previous infection or vaccination

55
Q

What do IgG antibodies indicate in Hep B serology?

A

Chronicity IgM signifies acute infection

56
Q

Screening for asymptomatic bacteriuria - which conditions?

A

All immunosuppressed pts whether through meds or pathology Pregnancy Renal transplant pts

57
Q

The DOC for lung abscess

A

Clindamycin

58
Q

Characteristics of giardiasis

A

non-bloody, watery diarrhoea, abdominal cramps, foul flatus, vomiting, fever and malaise.

Stools are malodorous, mushy and greasy.

Anorexia, fatigue and weight loss common.

59
Q

Characteristics of campylobacteriosis

A

inflammatory sometimes bloody diarrhoea or dysentery syndrome 1-3 days post ingestion of infected food (poultry)

60
Q

Characteristics of amebic colitis

A

Gradual onset over 1-2 weeks (cf bacterial dysentery). Cramp abdominal pain, watery or bloody diarrhoea, anorexia/ weight loss. Fever in about 30%

61
Q

What is elevated in 90% of HIV pts with PCP?

A

LDH

62
Q

Diagnosis of PCP

A

Examination of induced sputum

63
Q

Pasteurella multocida is associated with what?

A

Cat bites

64
Q

What tends to cause rapid onset nausea, diarrhoea + vomiting?

A

staphylococcal food poisoning

65
Q

What is the cause of tinea versicolor?

A

Malassezia yeast

66
Q

Prophylactic Rx for contacts of ppl with meningococcal meningitis should include what?

A

Rifampicin

67
Q

The most frequent cause of urethritis in men

A

Chlamydia

68
Q

Combination of DKA and sinus inflammation might indicate what?

A

Mucormycosis

69
Q

Management of Mucormycosis

A

surgical debridement and IV amphoteracin B

70
Q

Prophylaxis of mycobacterium avium intracellulare in HIV pt with a CD4 <50

A

Azithromycin

71
Q

Diagnosis of pseudomembranous colitis *hot topic*

A

cytotoxin assay of the stool

72
Q

Management of pseudomembranous colitis

A

Stop antibiotics and give oral vancomycin

73
Q

Treatment for gonorrhoea

A

Ceftriaxone IM as a single dose

74
Q

TOC for lung abscess

A

Clindamycin

75
Q

A drug approved for HIV associated lipodystrophy

A

Tesamorelin

76
Q

If someone presents with a dirty wound + hx of tetanus vx, when would you re-administer the vaccine?

A

If the vaccine was >5 years ago

77
Q

Fungal disease associated with bats and birds

A

Histoplasmosis

78
Q

What Ix is necessary in a sexually active woman of repro age with LUTS?

A

HCG

79
Q

Sputum culture for Legionella sp should be on which medium?

A

Buffered charcoal yeast agar

80
Q

The best way to evaluate the severity of PCP pneumonia

A

Alveolar-arterial P02 difference

81
Q

Management of latent TB infection in HIV

A

Isoniazid monotherapy

82
Q

First line antibiotic therapy for animal bites

A

Amoxycillin-clavulanate

83
Q

What type of virus is Epstein Barr?

A

Human Herpes Virus type 4 (dsDNA)

84
Q

Fever + pharyngitis + lymphadenopathy (posterior cervical LNs) + fatigue

A

Infectious Mononucleosis

85
Q

False negatives to the Monospot test (2)

A

1) Early infection (in which case re-test) 2) <4 years old (look for EBV specific antibodies like IgM VCA or IgG (EBNA)

86
Q

What are HIV+ pts with EBV at risk of developing?

A

Oral hairy leukoplakia

87
Q

Pulmonary tuberculosis is associated with what as an occupational disease?

A

Silica dust exposure

88
Q

Eaton’s agar media can be used to grow what from sputum culture?

A

Mycoplasma pneumonia

89
Q

Who tends to get mycoplasma pneumonia?

A

School kids, teenagers, military recruits

90
Q

Most reliable diagnostic tests for mycoplasma pneumonia

A

PCR and DNA probes

91
Q

A positive Widal test suggests what?

A

Typhoid fever

92
Q

Main routes of spread Hep C

A

IVDU Tattoos Not sexual contact!

93
Q

Investigation to assess severity of Hep C

A

Liver biopsy

94
Q

Blind Rx meningitis in >50s or immunocompromised pts

A

Vancomycin + ampicillin + ceftriaxone

95
Q

Diagnostic investigation for osteomyelitis

A

X-Ray

96
Q

X-Ray findings in osteomyelitis

A
  • Soft tissue swelling
  • Periosteal reaction
  • Cortical irregularity
  • Demineralisation
97
Q

Should an adult with a reported history of VZV be offered the VZV vaccine?

A

Yes according to the CDC and Canada Q Bank because the history may be unreliable

98
Q

For whom is pneumococcal 23-valent polysaccharide vaccine recommended

A
  1. All adults over 65 2. Adults <65 in care facilities or with LTCs that out them at risk 3. Alcoholics 4. Smokers 5. Homeless people 6. Asthma with COPD or on steroids 7. Drug users
99
Q
A

Tinea versicolor

100
Q
A

Erythema migrans

Lyme disease

101
Q
A

Oral hairy leukoplakia

EBV infection in HIV

102
Q
A

Secondary syphilis

103
Q
A

Historical illustration of chancoid ulcer and buboes

104
Q
A

Strawberry cervix, trichomonas

105
Q
A

Tinea corporis ring worm

106
Q
A

Argyll Robertson pupil

Tertiary syphilis

Accommodates but doesn’t react

107
Q
A

Pneumocystis carinii pneumonia

There are diffuse bilaterally symmetric interstitial patterns noted in the perihilar region and extending towards the periphery

108
Q
A

Tetanus

109
Q
A

Leprosy

Leonine facies

110
Q
A

Darkfield microscopy

Treponema pallidum

Spirochaetes

111
Q
A

Syphilitic aortitis

Tertiary syphilis

112
Q
A

Teritary syphilis

Posterior column degeneration

Tabes dorsalis

113
Q
A

TB- large cavitating lesion

114
Q
A

The auramine-rhodamine fluoresecent stain for acid fast bacilli has now repaced the Ziehl-Neelsen stain for sputum because it has higher sensitivity for diagnosing TB. Cultures take 3-4 weeks to grow.

115
Q
A

The PPD aka Mantoux test for TB

The initial test for screening pts for TB when primary Tb is suspected

116
Q
A

This is the rapid ELISA HIV test, with 99.5% sensitivity, if positive arrange Western blot confirmation by detection of antibodies to at least two different HIV protein bands (p24, gp41, gp120/160); specificity >99.99%

117
Q
A

Aspergilloma.

Ball of hyphae in a pre-existing lung cavity

Symptoms range from asymptomatic to massive hemoptysis

CXR: round opacity surrounded by a thin lucent rim of air, often in upper lobes (“air crescent” sign)

118
Q
A

Mucormycosis

Fungal pathogen of mold subtype

Usually caused by Rhizopus

Problematic in uncontrolled diabetics

Rx requires surgical debridement and IV amphoteracin B

119
Q
A

Computer illustration of Borrelia burgdorferi bacteria, the cause of Lyme disease in humans. These spiral-shaped spirochaete bacteria are passed on to humans by tick bites, commonly Ixodes ricinus in Europe and Ixodes pacificus in North America.

120
Q
A

Roth spots

Osler nodes

Janeway lesions

Splinter haemorrhages

Due to embolised bits of septic vegetation in infective endocarditis

121
Q

Treatment of latent TB in healthy individuals

A

Isoniazid 9 months

122
Q

What must always been done before a lumbar puncture?

A

Check for raised intracranial pressure.

Look for papilledema

123
Q

Significance of numerous RBCs in serial CSF samples

A

Subarachnoid haemorrrhage

124
Q

Significance of low glucose and PMN predominance in CSF sample

A

Bacterial meningitis

125
Q

Significance of normal glucose and lymphocytic predominance in CSF sample

A

Aseptic (viral) meningitis

126
Q

Risk factors for pyelonephritis

A
  • Pregnancy
  • Vesicoureteral reflux
  • Anatomical abnormalities
  • Indwelling catheters
  • Kidney stones
127
Q

Name the bug - an alcoholic with pneumonia

A

Klebsiella

128
Q

Name the bug- infection in a burns patient

A

Pseudomonas

129
Q

Name the bug- perianal itching

A

Enterobius vermicularis

130
Q

Name the bug- raw pork

A

Trichinella spiralis

MCCQE1 (20 decks)

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