Brainscape's Knowledge GenomeTM

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


See full index

path > microbiology > Flashcards

microbiology Flashcards

1
Q

cough + haemoptysis + fever + night sweats + weight loss + malaise for several weeks

A

TB

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

what may induce reactivation a latent TB infection in patients?

A

immunosuppression chronic alcohol excess malnutrition ageing reinfection

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

TB treatment 1st line

A

Rifampicin, Isoniazid (with B6 pyridoxine to prevent peripheral neuropathy), Pyrazinamide and Ethambutol for 2 months then Rifampicin and Isoniazid for the next 4 months

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

Rifampicin Side effects

A

orange-red secretions (tears/ urine etc) induces cytochrome p450 - many drug interactions

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

Isoniazid Side effects

A

peripheral neuropathy (give B6 pyridoxine) hepatotoxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Pyrazinamide side effects

A

hyperuricaemia, neurotoxicity

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

Ethambutol side effects

A

optic neuritis, visual disturbances

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

TB meningitis tx?

A

all four drugs (RIPE) for 2 months then R+I for next 10 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Latent TB treatment?

A

Isoniazid alone for 6 months or Isoniazid + rifampicin for 3 months

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

Ghon focus

A

TB - Ghon focus refers to a calcified tuberculous caseating granuloma - subpleural

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

caveating granulomas in the lung, upper lobes usually affected. may progress rapidly to cavitation.

A

TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how to diagnose/ investigate a TB infection?

A

Imaging: CXR/ CT For diagnosis- Culture: sputum (x3) for microscopy (ZN/ aura mine staining showing gram +ve rods, acid fast, aerobic, intracellular)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

screening for TB infection?

A

Mantoux test (a type IV hypersensitivity) - but also positive in those with BCG vaccination/ latent TB IGRA (IFN gamma release assay) - cannot distinguish active and latent TB but no cross reaction w BCG vaccination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Auramine- rhodamine stain

A

+ve for mycobactacterium helps visualise acid fast bacilli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

ziehl Neelson stain/ lowenstein-jensen medium

A

+ve for mycobacterium

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

BCG vaccine contains an attenuated strain of?

A

mycobacterium bovis

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

BCG vaccine used in?

A

at risk babies. e.g. from areas of high prevalence/ TB contacts contraindicated in HIV pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

spinal TB disease

A

Potts disease fever, sweats, weight loss, back pain verterbral destruction + collapse + anterior extension (causing iliopsoas abscess)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

pneumonia, low Na, hepatitis, assoc w travel, air conditioning units and water towers

A

legionella pneumophlia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

most common cause of lobar pneumonia, rusty coloured sputum. what organism?

A

strep pneumoniae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

pneumonia associated with recent viral infection (e.g. post influenza) + cavitation on CXR what organism?

A

staph aureus

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

pneumonia associated with heavy smoking and COPD what organism

A

haemophilus influenzae a gram -ve rod

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

pneumonia associated with alcoholism, elderly people and usually presents w haemoptysis. what organism

A

klebsiella pneumonia gram -ve rod

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

community acquired pneumonia associated with smoking. microscopy and staining shows a gram -ve coccus.

A

Moraxella catarrhalis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

pneumonia associated with younger children to young adults, may trigger erythema multiforme (SJS), cold agglutinin test (AIHA).

A

mycoplasma pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

most common cause of atypical pneumonia in adults

A

mycoplasma pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

atypical pneumonia associated w birds, splenomegaly, rash and haemolytic anaemia

A

chlamydia psittaci

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

pneumonia with poor response to Abx, where CXR shows upper lobe cavitation. Dx on Auramine/ Zn stain

A

TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

pneumonia associated with farm animals and hepaitis

A

coxiella burneti (Q fever)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

pneumonia/ whooping cough in those unvaccinated.

A

bordatella pertussis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what organisms cause Pneumonia assoc w HIV

A

Pneumocystis Jiroveci (PCP) esp if CD4<200 TB Cryptococcus neoformans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

most common causes of pneumonia in a 0-1 month old

A

e coli GBS listeria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

most common causes of pneumonia in a 1-6 month old

A

chlamydia trachomatis staph aureus RSV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

most common causes of pneumonia in a 6 month to 5 yr old

A

mycoplasma pneumonia, influenza

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

most common causes of pneumonia in a 16-30 yr old

A

mycoplasma pneumonia, strep pneumoniae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

most common resp tract infection if one has neutropenia

A

fungal infection- aspergillus spp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

silver GMS (Gomori methenamine silver) stain +ve, boat shaped organisms, bilateral ground glass shadowing on CXR

A

pneumocystis jiroveci PCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

post splenectomy- more at risk of which organisms?

A

n meningitidis s pneumonia h influenza

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what organisms are associated with chronic infection in cystic fibrosis patients?

A

pseudomonas aeruginosa burkholderia cepacia (v high mortality)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

post bone marrow transplant lung infection - what organisms

A

Aspergillus + CMV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what organisms can you test for with urine antigen test? (pneumonia)

A

strep pneumoniae legionella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

in pneumonia, antibody tests - paired serum samples comparing values at presentation and 2 wks after- are useful with?

A

organisms that are difficult to culture. can show the rise of Ab over time. e.g. chlamydia, legionella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Community acquired pneumonia 1st line tx if mild-moderate severity?

A

Amoxicillin or Clarithromycin if penicillin allergic for 5-7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

community acquired pneumonia 1st line if moderate-severe severity?

A

co-amoxiclav + clarithromycin for 2-3 wks if pen allergic: cefuroxime + clari

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

atypical pneumonia 1st line?

A

protein synthesis inhibitors clarithromycin + doxycycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

what Ix is useful in pneumonia?

A

FBC, WCC, CRP, U&Es Blood cultures, Sputum MCS ABG (Cap blood gas in children) CXR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

CURB-65

A

if 2-5 admit to hospital. manage as severe

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

Pseudomonas pneumonia tx?

A

Piperacillin + tazobactam (Tazocin) or Ciprofloxacin +/- Gentamicin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

MRSA pneumonia tx?

A

Vancomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Staph aureus pneumonia Tx?

A

flucloxacillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Legionella Hosp acquired pneumonia Tx?

A

clarithromycin + rifampicin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Hospital acquired pneumonia 1st line tx?

A

Ciprofloxacin + Vancomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Hospital acquire pneumonia 2nd line/ in ITU?

A

Piptazobactam + Vancomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Aspiration pneumonia tx?

A

need gram +/ - and anaerobic cover cefuroxime + metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

what causes genital ulcers?

A

painful- herpes simplex, chancroid painless- syphilis, donovanosis, LGV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

what may cause rashes/ lumps/ growths in the genital area?

A

genital warts- HPV pubic lice scabies molluscum contagiosum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

what is the most common cause of septic arthritis in a young adult?

A

neisseria gonorrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

complications of gonorrhoea

A

bartholins abscess salpingitis with irreversible tube damage, infected males - dysuria, frequency, mucopurulent discharge, prostatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

disseminated gonococcal infection symptoms? who gets it?

A

pts with complement deficiencies present with fever, vasculitic rash, arthritis, septicaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Diagnosis of gonorrhoea

A

urethral / rectal smears MCS - gold standard gram -ve diplococcus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

treatment for gonorrhoea

A

IM ceftriaxone if resistant- spectinomycin IM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

what chlamydia serovars are associated with genital tract infection?

A

chlamydia trachomatis serovars D-K

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

how to diagnose chlamydia STI?

A

NAAT (nucleic acid amplification tests) are gold standard as chlamydia is an obligate intracellular pathogen and cannot be cultured on agar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

complications of chlamydia STI

A

chronic pelvic pain ascending salpingitis-> PID increased risk ectopic and infertility increased risk endometriosis epididymitis reiters syndrome adult conjunctivitis opthlalmia neonatorum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

tx of chlamydia

A

doxycycline BD for 7 days or Azithromycin stat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

tx of chlamydia in pregnancy

A

azithromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

SEs of Doxycycline

A

photosensitivity, contraindicated in pregnancy due to disturbance of bone growth and discolouration of immature bones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Lymphogranuloma venereum - what organism?

A

chlamydia trachomatis serovars L1,2,3 causing a lymphatic infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Lymphogranuloma venereum presentation

A

generally painless ulcer + balanitis, proctitis, cervicitis -> painful inguinal buboes + inguinal lymphadenopathy (2/3 unilateral) -> abscess formation rectal presentations - more common in MSM in developed world. pain, tenesmus, rectal bleeding, mucous discharge.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

chlamydia: exists in two forms. which forms are stable and extracellular, and which are intracellular and metabolic active?

A

elementary bodies- stable and extracellular reticulate particles- intracellular and metabolically active

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Lymphogranuloma venereum tx?

A

same as chlamydia but for longer doxycycline for 21 days or azithromycin once a wk for 3 wks/ erythromycin for 21 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

syphilis organism?

A

treponema pallidum an obligate gram -ve spirochaete

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

diagnosis of syphilis?

A

to diagnose: detect antibodies against T pallidum antigens e.g. TPHA (t palladium haemagluttinin test) TPPA (t pallidum particle agglutination test) tests

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

what test is useful to monitor response to treatment of syphilis?

A

RPR as titre falls in response to treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

syphilis tx?

A

IM single dose benzathine penicillin if pen allergic doxycycline -monitor RPR, need a four fold reduction for tx to be considered successful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

common side effect of syphilis tx that causes fever, headache, myalgia and usually clears within 24 hours?

A

JH (jarisch-heimer) reaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

primary syphilis presentation

A

painless genital ulcer often solitary. may persist for 4-6 wks. + bilateral lymph node enlargement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

secondary syphilis presentation usually few months after infection

A

maculopapular rash on back, trunk, face, palms, soles mucosal lesions e.g. oral ulcers, genital warts low grade fever, malaise neuro involvement - cranial n palsies, optic neuritis, acute nerve deafness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

latent syphilis?

A

no obvious signs but serology positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

neurosyphilis presentation

A

argyll-robertson pupil - accommodates but does not react to light. small, irregular pupils. CSF shows spirochaete. psychosis with muscular reflex abnormality, dementia and seizures.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

pupils accommodate but do not react to light.

A

argyll-robertson pupil in neurosyphilis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

congenital syphilis presentation?

A

hepatosplenomegaly, rash, fever, neurosyphilis and pneumonitis. often develops over the first 2 years of life.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

neurosyphilis tx?

A

procaine penicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

chancroid what organism responsible?

A

haemophilus ducreyi a gram -ve cocobacillus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

tropical ulcer disease, frequently painful multiple ulcers. diagnosis via chocolate agar medium culture + PCR

A

chancroid.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

protein synthesis inhibitors - abx

A

30s subunit (AT) Aminoglycosides e.g. Gentamicin Tetracyclines e.g. Doxycycline 50s subunit (MOC) Macrolides- e.g. clarithromycin, erythromycin Oxazolidinone e.g. Linezolid Chloramphenicol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

molluscum contagiosum, what organism?

A

pox virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

donovonasis = granuloma inguinale, what organism?

A

klebsiella granulomatis. gram -ve bacillus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

large expanding ulcers starting as papule or nodule that breaks down. + beefy red appearance. diagnosis via Giemsa stain of biopsy + Donovan bodies

A

donovanosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

donovanosis tx

A

azithromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

greenish gray offensive discharge in women. + vulval soreness. O/E strawberry cervix diagnosis shows flagellated protozoan

A

trichomonas vaginalis trichomoniasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Trichomoniasis tx

A

metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

clue cells, high pH, whiff test +ve

A

bacterial vaginosis tx with metronidazole. assoc w preterm delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

white thick discharge, itching, soreness, redness. usually assoc w pregancy, diabetes mellitus, HIV, use of ABx, other immunosuppressive drugs

A

candidiasis candida albicans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

candidiasis tx?

A

oral fluclonazole, topical clotrimoazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

facial molluscum contagiosum in adults?

A

HIV until proven otherwise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

if tx required for molluscum contagiosum?

A

cryotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

genital warts tx?

A

1st line home tx: podophyllotoxin cream 2nd line: imiquimod or clinic tx- cryotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

seborrhoea dermatitis what organism?

A

malassezia furfur aka pityrosporum orbiculare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

tinea/ pityriasis versicolor (depigmentation in those with dark skin) what organism?

A

malassezia furfur aka Pityrosporum orbiculare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

athletes foot aka tinea pedis what organism?

A

most commonly - trichophyton rubrum caused by dermatophytes - fungi which inhabit dead layers of the skin and digests keratin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

invasive candidiasis tx?

A

amphotericin B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

often presents as pneumonia in immunocompromised, assoc with building work, cavitating lesion. also produces aflatoxin B1 which is carcinogenic and increases risk of Hepatocellular carcinom

A

aspergillus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

tx for aspergillus

A

voriconazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

fungus that grows on czapek dox agar

A

aspergillus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

insidious onset meningitis in HIV/ immunocompromised patients + associated with birds/ pigeons!

A

cryptococcus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

tx of cryptococcal infection

A

amphotericin B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

roseola infantum aka?

A

exanthem subitum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Roseola infantum - what causative organism?

A

HHV6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

most common cause of febrile convulsions

A

Roseola infantum HHV6 infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

CMV complications in immunocompromised

A

pneumonitis (in post BMT patients) retinitis (AIDs) hepatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

1st line tx of CMV infection

A

ganciclovir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

Infant with IUGR, jaundice, hepatosplenomegaly, microcephaly, chorioretinitis, late progressive sensorineural deafeness, with periventricular calcification.

A

CMV congenital infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

Owls eyes inclusions highly specific for?

A

CMV infection !! different from owls eyes appearance of entire nucleus (pathognomonic of reed Sternberg cells of Hodgkins lymphoma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

diagnosis of CMV?

A

serology- IgM and IgG CMV (if primary infection, IgM will be dominant) Blood PCR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

reactivation of CMV in post-transplant patients may cause?

A

encephalitis, bone marrow suppression, pneumonitis, hepatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

what is a worrying complication of genital HSV infection

A

urinary retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

if pregnant woman gets primary HSV infection during third trimester, tx?

A

before treating, do check if this is primary infection - type specific HIV Ab test oral acyclovir 6 weeks before estimated delivery date. if primary infection and less than 6 wks til estimated delivery, c-section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

neonatal HSV presentation

A

greatest risk of transmission from mother to fetus is if mother gets primary infection in third trimester (greatest at delivery) assoc w foetal loss, skin, eye, mouth lesions -> long term ocular and neuro sequelae encephalitis disseminated disease + vesicles (high mortality rate due to fulminant hepatitis and multi organ failure)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

neonatal HSV tx?

A

IV aciclovir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

complications of HSV?

A

erythema multiforme eczema herpeticum herpetic whitlow - painful red finger herpes gladiators - painful blisters + inguinal LNapothy, rugby players/ wrestlers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

what do you expect to see in a fetus with congenital varicella syndrome?

A

limb hypoplasia eye defects - cataracts, choreoretinitis skin scarring neuro defects - microcephaly, cortical atrophy disseminated haemorrhagic varicella infection if within 7 days of delivery - purpura fulminans (30% mortality)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

chicken pox post exposure prophylaxis

A

VZIG, within 10 days of exposure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

in pregnant women, increased risk of which complications with chicken pox infection?

A

pneumonitis encephalitis hepatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

complications of shingles (VZV reactivation)

A

painful rash in specific dermatome

post herpetic neuralgia

ramsay-hunt syndrome (reactivation in facial n near ear- vesicles in ear, hearing loss, facial n palsy)

Guillain-barre syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

infectious mononucleosis most common cause

A

EBV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

fever, tonsillar enlargement + exudates, pharyngitis, lymphadenopathy + splenomegaly + maculopapular rash + atypical lymphocytosis

A

glandular fever, infectious mono

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

diagnosis of infectious mono?

A

blood film (atypical lymphocytes)

EBV antibodies (IgM EBV)

Paul Bunnell test/ monospot test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

important risk/ complication of infectious mono?

A

risk of splenic rupture -> may need abdo USS and splenectomy ask patients to avoid contact sports for next few wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

HHV8 assoc with?

A

Kaposis Sarcoma Castlemans disease (non cancerous growth in the Lymph nodes) Primary effusion lymphoma (HIV associated malignant effusions without tumour mass)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

PUO? definition?

A

>38.3 fever on several occasions persisting >3/52 without diagnosis despite >1/52 of intensive Ix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

which malaria species causes a quartan fever?

A

a quartan fever is one every 72 h plasmodium malariae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

which malaria species causes a tertian fever?

A

a tertian fever is one every 48h plasmodium falciparum p vivax p ovale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

fever in returning traveller- always consider?

A

malaria, dengue, typhoid fever, bacterial diarrhoea etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

what organisms cause typhoid/ enteric fever?

A

salmonella typhi and paratyphi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

infecting Peyer’s patches. Rose spots, fever, headache, abdo pain, constipation, relative bradycardia, hepatosplenomegaly.

A

Typhoid fever -salmonella typhi/ paratyphi. - gram -ve rods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

typhoid fever tx?

A

Iv fluids, IV/oral abx (Ceftriaxone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

diagnosis of typhoid fever?

A

blood cultures (usually bactaraemia present) stool culture shows gram - rod

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

which organism causes the most severe form of malaria

A

p falciparum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

which organism causes a benign Malaria which may manifest more than 1 year after infection?

A

plasmodium malariae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

which organisms cause the more indolent malaria, with hypnozoites in the chronic liver stage?

A

p vivax and p ovale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

what is primaquine used for?

A

eradicates hypnozoites which are dormant forms in the life cycles of the plasmodium species. - useful in p vivax and p ovale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

blood film shows young trophozoites (rings) in the absence of mature trophozoites and schizonts. crescent-shaped gametocytes. + Bloods show >2% parasitaemia

A

p. falciparum malaria infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

blood film shows schuffners dots

A

p vivax and p ovale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

blood film shows schuffners dots and >20 merozites/ schizont

A

p vivax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

p falciparum tx?

A

exchange transfusion if >10% parasitaemia

if uncomplicated: Quinine + doxycycline or Clindamycin if pregnant or

Malarone (Atovoquone/ Proguanil) or

Riamet (artemether/lumefantrine)

if complicated: IV artesunate

medical emergency

Always admit!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

p vivax and p ovale tx?

A

choroquine then primaquine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

what is the thick and thin blood film used for?

A

thick blood film used to diagnose malarial infection

thin blood film to allow species identification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

Primaquine - contraindications?

A

contraindicated in pregnancy and breastfeeding

and increases risk of haemolysis in G6PD deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

fever, splenomegaly, rigors, headache, flu-like illness, myalgia, n+v

+

thick blood film +ve

A

malaria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

malaria ix?

A

70% patients have low Platelets,

50% deranged LFTs,

30% anaemia

if severe:

acidosis, renal impairment, hypoglycaemia, anaemia, DIC, shock, haemoglobinuria, jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

first line tx of UTI?

A

trimethoprim

nitrofurantoin in pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

quinine side effects

A

nausea, deafness, tinnitus, monitor blood glucose

IV:

arrhythmogenic and causes hypoglycaemia

-> cardiac and Blood gluc monitoring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

fever, headache, myalgia, eschar (dark scab/ falling away of dead skin)

  • > vasculitis
  • > spread by vector: tick, mite, lice
A

Rickettsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

rickettsia tx?

A

doxycycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

what abx inhibit cell wall synthesis?

A

Beta lactams

  • Penicillins e.g. Benzylpenicillin
  • Cephalosporins e.g. Ceftriaxone
  • Carbapenems e.g. meropenem

and

Glycopeptides

e.g. vancomycin, teicoplanin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

e.g. of glycopeptide?

A

vancomycin for MRSA, 2nd line C.diff

teicoplanin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

most common cause of UTI

A

e coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

chloramphenicol side effects?

A

given as eye drops for bacterial conjunctivitis e.g.

risk of aplastic anaemia, grey baby syndrome in neonates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

what abx inhibit DNA synthesis?

A

Fluoroquinolones

e.g. Ciprofloxacin

for gram -ve

Nitroimidazoles

e.g. Metronidazole

for anaerobes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

what UTI-causing organism is assoc with function/ anatomical abnormalities of the renal tract

A

klebsiella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

what antibiotics inhibit RNA synthesis?

A

Rifamycin e.g. Rifampicin

indicated for mycobacteria e.g. TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

what antibiotics inhibit folate metabolism

A

sulfonamides

e.g. sulphamethoxazole

(indicated for PCP, forms co-trimoxazole with trimethoprim)

diaminopyrimidines

e.g. trimethoprim

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

what antibiotics target cell membranes?

A

polymxin

e.g. colistin

cyclic lipopeptide

e.g. daptomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

what is the 2nd most common cause of uncomplicated UTI?

A

staph saprophyticus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

GI infection + ate canned/ vacuum packed foods e.g. honey in kids, beans in students. -> ingestion of preformed toxin.

Descending paralysis

A

clostridia botulinum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

clostridia botulinum tx

A

antitoxin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

pseudomembranous colitis caused by abx use (usually cephalosporins/ ciprofloxacin/ clindamycin). releases 2 exotoxins A and B.

A

c difficile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

c difficile pseudomembranous colitis tx

A

metronidazole

2nd line- vancomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

reheated rice and sudden vomiting.

heat stable emetic toxin and heat labile diarrhoeal toxin. watery non bloody diarrhoea.

A

bacillus cereus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

what organism causes gas gangrene?

A

clostridia perfringens

gas gangrene is a bacterial infection that produces gas in gangrenous tissues - medical emergency caused by exotoxin - alpha toxin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

reheated meats, superantigen enterotoxin, watery diarrhoea + cramps, lasts 24 hours

+ may cause gas gangrene

A

clostridia perfringens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

gram + cocci in clusters, beta haemolytic. Catalase, coagulase +ve

produces entertoxin that acts as superantigen -> causing prominent vomiting and watery, non bloody diarrhoea.

Main virulence factor: protein A.

A

staph aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
174
Q

most common cause of travellers diarrhoea

A

e coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
175
Q

Anaemia, thrombocytopenia, renal failure following diarrhoea + recent visit to farm

A

Haemolytic Uraemic Syndrome (E. coli strain 0157)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
176
Q

rice water stool

enterotoxin with A/B subunit -> efflux of Cl- to lumen and loss of H2O and electrolytes

massive diarrhoea

A

vibrio cholera

tx: supportive, fluids and electrolytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
177
Q

ingestion of raw undercooked seafood, shellfish. comma shaped organism.

A

vibrio parahaemolyticus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
178
Q

cellulitis in shellfish handlers,

fatal septicaemia with diarrhoea and vomiting in HIV patients.

comma shaped organism

A

vibrio vulnificus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
179
Q

Tx of vibrio parahaemolytics and vibrio vulnificus

A

doxycycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
180
Q

unpasteurised milk/ food e.g. poultry

headache, fever + abdo cramps + bloody foul smelling diarrhoea.

curved, s shaped, motile bacteria

assoc w guillain barre syndrome, reactive arthritis

A

campylobacter jejuni

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
181
Q

Beta haemolytic, aesculin +ve, tumbling motility

GI: watery diarrhoea, cramps, headache, fever

assoc with immunocompromised patients, perinatal infection

unpasteruised dairy, veggies

A

listeria monocytogenes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
182
Q

motile trophozoite in diarrhoea. histology shows flask shaped ulcer.

dysentery, wind, tenesmus

chronic weight loss + RUQ pain due to *liver abscess + swinging fevers

assoc w MSM

A

entamoeba histolytica

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
183
Q

what organism is associated with recurrent aseptic lymphocytic meningitis?

A

HSV type 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
184
Q

Pear shaped trophozoite

trophozoites/ cysts in stool

assoc w travellers/ hikers/ MSM

malabsorption of protein and fat + foul smelling non bloody diarrhoea. may be of very long duration

A

giardia lamblia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
185
Q

tx for giardia lamblia

A

metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
186
Q

causes severe diarrhoea in the immunocompromised. e.g. HIV

profuse, water diarrhoea

oocytes seen in stool

Kinyoun acid fast stain +ve

A

cryptosporidium parvum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
187
Q

most common cause of gastroenteritis in <6 yrs. assoc w outbreaks

A

rotavirus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
188
Q

what is a prion disease?

A

protein-only infectious disease

rare transmissable spongiform encephalopathies resulting in rapid neuro degeneration and death in months

untreatable

due to variant PrP protein (PrPsc) abnormally folding to form insoluble configurations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
189
Q

hospital actuired surgical site infection: consider which organisms?

A

MRSA

Coagulase negative staphylococcus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
190
Q

CSF: 14-3-3 protein +ve

A

sporadic CJD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
191
Q

what biopsy is 100% specific and sensitive in diagnosing variant CJD?

A

tonsillar biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
192
Q

rapid, progressive dementia with myoclonus, cortical blindness, akinetic mutism and LMN signs

mean onset 45-75 yrs

mean survival time 6 months

EEG shows periodic triphasic changes.

Genetics: most have 129 codon MM polymorphism

Post mortem shows spongiform vacuolation on brain biopsy, and PrP amyloid plaques

A

Sporadic CJD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
193
Q

exposure to bovine spongiform encephalopathy.

young age of onset. mean survival 14 months.

psychiatric symptoms (anxiety, paranoia, hallucinations)

followed by

neuro symptoms (peripheral sensory symptoms, ataxia and myoclonus)

then dementia, chorea, ataxia

A

variant CJD

194
Q

which CJD has the lowest mean age of onset?

A

variant CJD - around 30

sporadic - 45-75

familial CJD - around 50

195
Q

which type of CJD is linked to exposure of bovine spongiform encephalopathy?

A

variant CJD

196
Q

which type of CJD has the lowest survival time?

A

sporadic CJD - mean survival time is 6 months from when symptoms start

197
Q

which type of CJD sees patients who ALL have a 129 codon Methionine-Methionine polymorphism?

A

variant CJD

198
Q

inherited prion disease - what mutation?

A

autosomal dominant

PNRP mutation - diagnostic

causes familial CJD, GSS (Gerstmann-Straussler-Scheinker syndrome), fatal familal insomnia

199
Q

which type of CJD has EEG changes showing perioding triphasic changes?

A

sporadic CJD

200
Q

posterior thalamus highlighted on MRI - pulvinar sign positive

All patients have codon 129 MM polymorphism

Tonsillar biopsy diagnostic

Post mortem- PrPsc detectable in CNS + lymphoreticular tissue

A

variant CJD

201
Q

CJD tx

A

symptomatic: clonazepam for myoclonus

delaying prion conversion: quinacrine, pentosan, tetracycline

202
Q

do psychiatric or neurological symptoms appear first in variant CJD?

A

pyschiatric first

paranoia, anxiety, hallucinations

203
Q

progressive ataxia, dementia and myoclonus.

history of neurosurgery in the past

Most are homozygous at codon 129 MM or VV

A

iatrogenic CJD

  • due to inoculation with human prions most commonly from surgery
204
Q

exposure to human prions from cannibalistic feasts

progressive cerebellar syndrome and death within 2 years

45 yr incubation

A

kuru

205
Q

autosomal dominant condition

PRNP mutation +

mean survival- 5yrs

presents w dysarthria progressing to cerebellar ataxia ending in dementia

A

Gerstmann-Straussler-Scheinker syndrome

GSS

206
Q

autosomal dominant condition

insomnia and paranoia progressing to hallucinations and weight loss. then a mute period.

death 1 month to 1.5 years after start.

PRNP mutation +

A

fatal familial insomnia

207
Q

gram -ve aerobic bacilli

consumption of untreated dairy products/ contaminated food/ animal contact

undulant fever (peaks in evening)

+ malaise, rigors, sweating, myalgia/ arthragia, tiredness, bone pain

Serology- shows anti-O-polysaccharide antibody

A

Brucellosis

208
Q

Brucellosis Ix?

A

WCC usually normal

Culture Bone Marrow (>90% +ve)

Blood cultures (70% +ve)

serology- anti-O-polysaccharide antibody

significant no neutropenic

209
Q

Brucellosis tx?

A

Doxycycline combined with Streptomycin

for 4-6 wks

or Doxycycline + rifampicin

210
Q

fatal encephalitis with prodrome of fever, sore throat

Negri bodies

following animal bite

A

rabies

rhabdovirus

211
Q

Rabies tx?

A

PEP Rabies IgG

212
Q

Negri bodies pathognomonic of?

A

Rabies

213
Q

Following flea bite,

swollen LNs (Bubo)

+ acral gangrene

A

yersinia pestis

tx: streptomycin, doxycycline, gentamicin, chloramphenicol (in meningitis)

214
Q

red currant jelly sputum

alcoholics

upper lobe consolidation w marked carvitation

more likely to lead to lung abscesses/ empyemas than pneumonias caused by strep pneumo

A

klebsiella pneumoniae

215
Q

swimming in contaminated water.

organism is a gram -ve, obligate, motile spirochaete

High spiking temp + headache + conjunctival haemorrhages + jaundice + malasie + myalgia + haemolytic anaemia

A

Leptospirosis

tx- amoxicillin, erythromycin, doxycycline or ampicillin

216
Q

painless round black lesions + rim of oedema

A

bacillus anthracis -anthrax

tx: ciprofloxacin/ doxycycline

217
Q

bullseye rash - erythema chronicum migrans

+ tick bite +

cyclical fevers, malaise, LNopathy + arthritis, nerve palsies, hepatitis, carditis

A

Lyme disease

-borrelia burgdoferi

218
Q

acrodermatitis chronic atrophicans (ACA)

+ focal neurology + arthritis + neuropsychiatric disturbance

A

late persistent lyme disease

219
Q

Lyme disease Ix and Tx?

A

Ix- biopsy edge of ECM +

Lyme Abs ELISA

Tx: Doxycycline for 2-3 wks

if CNS issues: IV ceftriaxone for 2-4 wks

220
Q

zoonosis

that looks like atypical pneumonia

fever, dry cough, fatigue, pleural effusion, diarhhoea, NO rash

A

Q fever

  • coxiella burnetti
221
Q

sandfly bite

skin ulcer at site of bite - may be single or multiple painless nodules whcih grow and ulcerate

A

cutaneous leishmaniasis

222
Q

zoonosis

usually young malnourished child, abdo discomfort + distension, anorexia and weight loss,

invasion of reticuloendothelial system -> hepatosplenomegaly, BM invasion

later disfiguring dermal disease, skin hyperpigmentation and dry warty skin

A

visceral leishmaniasis

aka

Kala Azar

223
Q

antiviral that inhibits neuraminidase

A

oral oseltamivir (tamiflu)

inhaled/ iv zanamivir (relenza)

224
Q

2-4 wks after group A strep throat infection

rash

chorea

heart valve involvement (most often mitral stenosis- MDM)

A

rheumatic fever

225
Q

risk factors of infective endocarditis

A

structural heart disease

prosthetic valves

poor dentition

long term lines

prior bacteraemia

bowel/GI issue

226
Q

most common cause of subacute bacterial endocarditis

A

strep viridans

tx: benzylpenicillin + gentamicin

227
Q

mild-moderate illness progressing over weeks- months. often PUO

fever, malaise, weight loss

heart murmur that changes

clubbing, splinter haemorrhages, osler’s nodes, janeway lesions, Roth spots, splenomegaly, haematuria

A

subacute bacterial endocarditis

(subtype of infective endocarditis)

228
Q

fulminant illness in days

fever, anorexia, weight loss, malaise, rigors, night sweats

new onset heart murmur

A

acute infective endocarditis

229
Q

most common cause of acute infective endocarditis in general?

in IVDU?

A

in general/ IVDU: staph aureus

in prosthetic valves: still staph aureus, but 2nd most common- coagulase negative staphylococci

230
Q

tx of MSSA endocarditis? and MRSA?

A

MSSA endocarditis

IV flucloxacillin for 4 wks

MRSA- Vancomycin + Gentamicin/ Rifampicin/ Fucidin

231
Q

in IVDU, which valve is most commonly affected (infective endocarditis)

A

tricuspid

232
Q

alpha haemolytic Gram + cocci in pairs (chains) - diplococci

A

strep pneumoniae

233
Q

how to differentiate strep pneumoniae from strep viridans?st

A

strep pneumoniae is optochin sensitive

and strep viridans is optochin insensitive

234
Q

beta haemolytic gram positive cocci in grape like clusters

A

staph aureus

all staphylococci are catalase positive

whereas all streptococci are catalase negative

235
Q

aerobic gram negative diplococci that is particularly problematic in patients with chronic lung disease and causes exacerbations of COPD.

also infects ears, eyes and CNS

A

moraxella catarrhalis

236
Q

beta haemolytic Gram + rod

outbreaks of non invasive gastroenteritis

sources include refrigerated food and unpasteurized dairy products.

clinical features include watery diarrhoea, abdo cramps, headaches and fever.

‘tumbling motility’ as a result of flaggelar- driven movements

Neonates and immunocompromised patients are particularly susceptible

A

Listeria Monocytogenes

237
Q

pear-shaped trophozoite

transmission occurs via ingestion of a cyst from faecally contaminated water and food.

Trophozoites attach to the duodenum but do not invade. Instead, protein absorption is inhibited, drawing water into the lumen of the GI tract.

so clinically: foul smelling non bloody diarrhoea produced (like coeliac)

Assoc w travellers, hikers, homosexual men

Microscopy shows stool containing cysts

A

giardia lamblia

238
Q

which gastroenteritis causing bacteria produces the exotoxin TSST-1

which acts as a superantigen causing non specific activation of T cells and subsequent release of IL1, IL2, and TNFa.

-> massive shock and organ failure.

the enterotoxin produced by the bacteria causes vomiting and diarrhoea 12-24 hours after the culprit food has been consumed

A

staph aureus

239
Q

slow onset fever, constipation, splenomegaly

multiplies in Peyers patches of the small intestine

Rose spots are pathognomonic (red macules 2-4 mm in diameter)

A

salmonella typhi

240
Q

motile trophozite

ingestion of the cysts leads to colonization of the caecum and colon

which may cause a flask shaped ulcer to develop

clinical features include dysentery, chronic weight loss, liver abscess formation

A

entamoeba histolytica

241
Q

oxidase positive, non motile bacteria

causing watery, foul smelling diarrhoea

complications include guillain barre and reiters syndrome

A

campylobacter jejuni

242
Q

subacute or chronic meningitis

symptoms include fever, headache, confusion

focal signs may be present as a result of a cerebral granuloma

* Rich focus

A

Mycobacterium tuberculosis

Rich focus: a tuberculous granuloma that occurs in the cortex of the brain subsequently rupturing into the subarachnoid space

CSF usually appears colourless and characteristically has high protein, low glucose, raised lymphocytes. Nucleic acid amplification tests + CT/MRI may be useful in the diagnostic work up

243
Q

first stage of infection: sudden fever, accompanied by chills, intense headache, severe myalgia, abdo pain, conjunctival suffusion (red eye) + skin rah.

asymptomatic for 3-4 days before second phase

where another episode of fever, meningitis*.

if severe, weil’s disease develops, compromising of liver damage (jaundice), kidney failure and bleeding

A

Leptospirosis

  • leptospira interrogans

transmission via contact w animals

CSF will show a raised WCC

gold standard for diagnosis - microscopic agglutination test (serological test)

244
Q

2 causes of subacute/ chronic meningitis in HIV patients?

A

TB

Cryptococcus neoformans

245
Q

subacute / chronic meningoencephalitis

CSF india ink staining reveals yeast cells w a surrounding halo

A

cryptococcus neoformans

source: pigeon droppings

cryptococcal antigen test is a more sensitive test than CSF staining

246
Q

what serovars cause genital chlamydia?

A

chlamydia trachomatis serovars D-K

247
Q

what serovars cause lymphogranuloma venereum?

A

chlamydia trachomatis serovars L1, L2, L3

248
Q

tabes dorsalis

  • what is it
  • what condition is it seen in
A

aka syphilitic myelopathy

occurs in tertiary syphilis

tabes dorsalis is the slow demyelination of the dorsal columns of the spinal cord -> affected one’s proprioception, vibration and discriminative touch

leads to argyll roberston pupil

  • eventually may lead to paralysis, dementia and blindness
249
Q

chancroid vs syphilis presentation?

A

chancroid: painful genital ulcer that leads to unilateral painful swollen inguinal LNs
syphilis: painless ulcer w bilater painless lymphadenopathy

250
Q

what medium is used to culture neisseria gonorrhoea?

A

Thayer-Martin VCN medium

251
Q

donavonosis

  • what organism
  • what stain
A

klebsiella granulomatis

a gram + rod

diagnosed via Giemsa stain of biopsy, showing Donovan bodies

252
Q

trimethoprim side effects, contraindications

A

trimethoprim is an inhibitor of folate metabolism

should be used in caution w patients w megaloblastic anaemia due to its interaction w folate

side effects include thrombocytopenia, megaloblastic anaemia and hyperK

253
Q

what is cotrimoxazole?

A

trimethoprim + sulphamethoxazole

used in treatment of pneumocystis jirovecii

both are from classes of abx that inhibit folate metabolism

254
Q

side effects of vancomycin

A

ototoxicity

renal failure

blood disorders

rash

anaphylaxis

255
Q

meningitis in community: immediate treatment

A

IM benzylpenicillin until transferred to secondary care unit

cefotaxime/ ceftriaxone then started

256
Q

what else is cefotaxime useful for?

apart from meningitis

A

tx of pyelonephritis

sepsis secondary to hospital acquired pneumonia

soft tissue infections

257
Q

EBV infects what cells?

A

B lymphocytes

258
Q

influenza

  • what components of the virus bind to which parts of the host?
A

infleunza virus is a spherical virion with haemagglutinin and neuramindase glycoproteins on the surface

HA binds to sialic acid receptors present in the upper resp tract

viral RNA is subsequently inserted into the host cell and HA is cleaved by clara cell tryptase

NA cleaves neuraminic acid, a component of protective mucin. protective barrier is thus disrupted exposing the sialic acid receptor sites beneath

NA also has a role facilitating the release of newly formed influenza virions

259
Q

how does IFN alpha work in the treatment of hep B/C?

A

IFN alpha potentiates the immune system to fight active viral infection.

IFN alpha acts on the JAK-STAT pathway eventually leading to the synthesis of anti viral proteins.

A NRTI and IFNa is the std tx for hep B infection

in Hep C, pegylated IFN a is used. (half life of the drug increased with the addition of polyethylene glycol)

260
Q

how does oseltamivir work?

A

a viral neuraminidase inhibitor

-> prevents further viral replication

261
Q

gancyclovir

used for?

common SE?

A

used for CMV, EBV and HHV6 infection

can cause bone marrow toxicity

hence may be prescribed together with G-CSF (granulocyte colony stimulating factor

262
Q

acyclovir

what is it?

how is activated in the body?

A

a guanosine analogue anti-viral drug

it is converted to acycl-GMP by viral thymidine kinase.

then further phosphorylated to acyclo-GTP

Acyclo-GTP is the active form, which is incorporated into the viral DNA strand, terminating the chain and stopping DNA polymerase from functioning.

263
Q

what is the active form of acyclovir?

A

acyclo-GTP

acyclo- guanosine triphosphate

264
Q

what is amantadine

A

an M2 ion channel inhibitor preventing the uncoating of influenza virions and therefore inhibiting entry into susceptible cells

265
Q

oral thrush - creamy white patches with red base over mucous membranes of mouth

can lead to oesophagitis, characterized by odynophagia

what organism?

what treatment?

A

candida albicans

oral thrush - treat with nystatin

can be diagnosed by testing for blood beta-D-glucan (a component of fungal cell wall)

266
Q

complications of cryptococcal meningitis

A

fatal without treatment

due to associated cerebral oedema

and brainstem compression

267
Q

hypopigmentation in patients w dark skin,

hyperpigmentation in patients w pale skin

spots affect back, arms, legs, chest, underarm, neck

what organism is causing this?

whats the name of the condition?

A

pityriasis versicolor

  • malassezia furfur

*microscopy reveals ‘spaghetti w meatballs’ appearance

woods light may reveal an orange fluoresence

268
Q

rose gardeners disease

prick by thorns cause nodular lesions to appear on the surface of the skin.

Initially the lesions will be small and painless, left untreated they become ulcerated.

infection may spread to joints, bone and muscle.

inhalation of spores may lead to pulmonary disease

what organism?

A

a fungus - Sporothrix Schenckii

causing sporotrichosis

tx: itraconazole, fluconazole and oral potassium iodide

269
Q

aspergillus flavus may produce which carcinogen?

assoc w?

A

aflatoxin

hepatocellular carcinoma

270
Q

aspergillus can cause which few diseases?

A

ABPA allergic broncho-pulmonary aspergillosis

allergic reaction in the airways due to an IgE mediated type I hypersensitivity reaction leading to bronchospasm and eosinophilia.

Aspergilloma:

infection in pre-formed lung cavitiy e.g. TB may lead to fungal ball visible on CXR

Invasive aspergillosis:

chronic necrotizing infection that may occur in neutropenic (chemotx) patients or patients with AIDS (CD4<50)

271
Q

cutaneous dermatophyte fungal infection of the scalp leading to scaly red lesions with loss of hair

primarily affecting children

infection is characterised by an expanding ring on the scalp

A

tinea capitis

272
Q

raised red rings

cutaneous dermatophyte fungal infection affecting the trunk, arms and legs

A

ring worm

tinea corporis

273
Q

rocky mountain spotted fever

A

caused by Rickettsia infection

transmitted to humans by ticks

rickettsia bacteria invade the endothelial lining of capillaries causing a vasculitis.

clinical features include headache, fever, mylagia, vomiting and confusion

late signs include a rash that is maculopapular and or petechial on the distal parts of the limb which then spreads to the trunk and face.

may lead to thrombocytopenia, hypoNa, and or elevated liver enzymes

274
Q

contact with birds

severe pneumonia + splenomegaly + epistaxis

hepatitis

haemolytic anaemia, rash (horder’s spots)

A

psittacosis

chlamydia psittaci

275
Q

what is pathognomonic of Rabies

A

cerebral negri bodies

276
Q

bite or scratch

leading to progressive and incurable encephalitis, hydrophobia and muscle spasm

A

Rabies

Cerebral negri bodies (inclusion bodies) are pathognomonic

277
Q

cat scratch leading to tender and swollen lymph nodes with headache and backache.

atypically may cause parinaud’s oculoglandular syndrome- granulomatous conjunctivitis in one eye and swollen LNs in front of the ear on the same side

A

Cat scratch disease

caused by Bartonella spp

278
Q

fever, malaise, transient hearing loss

parotitis with unilateral or bilateral swelling and pain on chewing

plasma amylase levels elevated

complications such as viral meningitis, orchitis/ oophoritis, mastitis and arthritis may result

A

Mumps infection

MMR vaccine normally given at 12-13 months and again as a preschool booster

279
Q

if abx fails to tx pneumonia, consider:

A

· Empyema / abscess

· Proximal obstruction (tumour)

· Resistant organism (incl. Tb)

· Not receiving / absorbing Abx

· Immunosuppression

Other diagnosis - Lung cancer, cryptogenic organising pneumonia

280
Q

how to detect legionella pneumophila

A
  • buffered charcoal yeast extract culture
  • urine serology for antigen
281
Q

contact with domestic/ farm animals

flu-lie symptoms, fever, malaise, sweats

less often: granulomatous hepatitis, retinal vasculitis,

chronic endocarditis

dx by serology

A

Q fever

-coxiella burnetti

282
Q

a hospital acquired pneumonia is when?

A

any pneumonia contracted by patient in a hospital at least 48-72 h after being admitted

283
Q

being neutropenic makes one more susceptible to what type of pneumonia?

A

aspergillus

284
Q

empiric antibiotic therapy for mod-severe community acquired pneumonia

A

co-amoxiclav + clarithromycin

if allergic: cefuroxime + clarithromycin

285
Q

glycopeptides

  • how does it work
  • e.g.?
A

· Large molecules, unable to penetrate Gram –ve outer cell wall, only active against Gram +ve

· Inhibit cell wall synthesis

· Important for treating serious MRSA infections (iv only)

e.g. vancomycin, teicoplanin

*nephrotoxic - impt to monitor drug lvls

286
Q

tetracyclines

  • how does it work
  • e.gs
A

· Broad-spectrum agents with activity against intracellular pathogens (e.g. chlamydiae, rickettsiae & mycoplasmas) as well as most conventional bacteria

· Bacteriostatic, inhibit protein synthesis by preventing binding of aminoacyl-tRNA to the ribosomal acceptor site

287
Q

when do you use oxazolidinones e.g. linezolid?

A

VRE

MRSA

should only be used with consultant ID approval

neuro side effect - dont give for >4 wks

288
Q

how does salmonella enteritidis cause pathology in an affected person?

A

Enterocolitis

· loose stool, diarrhea type of presentation

· transmitted from poultry, eggs,meat

· invasion of epi-and sub-epithelial, tissue of small and large bowel

· No fever, bacteraemia infrequent

· self limited, non-bloody diarrhoea, usually no treatment

289
Q

cellulitis in shellfish handlers (get cut by shellfish corals in sea divers)

fatal septicaemia with D+V in immunocompromised eg HIV patients

Treat with doxycycline

A

vibrio vulnificus

290
Q

Transmitted via food contaminated with domestic animals’ excreta (farming activities)

Enterocolitis, mesenteric adenitis

associated with extra GI symptoms - reactive arthritis, Reiter’s

A

yersinia enterocolitica

291
Q

· motile trophozoite in diarrhoea

· non-motile cyst in non-diarrhoeal illness

· Killed by boiling, removed by water filters

“flask shaped” ulcer

· dysentery, flatulence, tenesmus

if chronic: can cause weight loss +/- diarrhoea

liver abscess

diagnosis: stool micro to look for procytes and serology in invasive disease

A

entamoeba histolytica

tx: metronidazole for the stool + paromomycin in luminal disease

292
Q

infects the jejunum

severe diarrhoea in the immunocompromised

oocysts seen in stool by modified kinyoun acid fast stain

A

cryptosporidium parvum

293
Q

what are the 3 factors that contribute to surgical site infection risk?

A

host defence

wound environment

pathogen

294
Q

negative pressure isolation vs positive pressure isolation

A

· Negative pressure isolation – protection of others from an infectious patient with airborne infection

· Positive pressure isolation – protection of transplant patients from organisms from outside the room

295
Q

3 levels of surgical site infection

A
  1. superficial incisional - affect skin and subcut tissue
  2. deep incisional - affect fascial and muscle layers
  3. organ/ space infection- any part of anatomy other than the incision
296
Q

What are some patient-dependent risk factors of surgical site infections?

A

age >65

any underlying illness e.g. diabetes, malnutrition, rheumatoid

obesity - adipose tissue is poorly vascularised

smoking - nicotine itself delays primary wound healing. + may have peripheral vascular disease

297
Q

what are some measures taken prior to surgery to prevent surgical site infections?

A

pre-operative showering

hair removal: use electric clippers instead of razor if hair needs to be removed (microabrasions caused by razor shaving may lead to multiplication of bacteria)

nasal decontamination: e.g. staph aureus risk factor for SSI following cardiothoracic surgery

abx prophylaxis

298
Q

what measures to take during the surgery to reduce risk of surgical site infection?

A

mx of infected/ colonised surgical personnel

reduce theatre traffic to a minimum

ventilation of theatre: maintain positive pressure ventilation. consider laminar flow for orthopaedic implant surgery

sterilise all surgical instruments

skin prep: using antiseptic iodine or chlorhexidine

aseptic surgical technique

normothermia: mild hypothermia appears to increase risk of SSIs by causing vasoconstriction, decreased delivery of oxygen to wound space and subsequent impairment of neutrophil function

maintain optimal oxygen during surgery

299
Q

why is staph aureus so effective at causing joint infection?

A

s aureus has receptors such as fibronectin binding protein that allows binding to synovial membrane (e.g. fibronectin found when joint is damaged)

s aureus produces the cytotoxin PVL Panton valentine leucocidin which have been associated with fulminant infections

300
Q

septic arthritis investigations

A

Blood culture before antibiotics are given

Synovial fluid aspiration for M&C

ESR, CRP - traditionally a synovial count> 50,000 WBC cells/mm3 used to suggest septic arthritis

(Negative culture does not exclude septic arthritis)

Imaging:

US - confirm effusion and guide aspiration

CT - erosive bone change, periarticular soft tissue extension

MRI (done if osteomyelitis is suspected) - joint effusion, articular cartilage destruction, abscess, contiguous osteomyelitis

301
Q

mx of septic arthritis

A

antibiotics- up to 4-6 wks of IV antibiotics may be given (flucloxacillin or cephalosporin)

if MRSA- vancomycin

drainage- washout of joint

302
Q

what are some routes of infection in vertebral osteomyelitis

A

acute haematogenous

local spread

303
Q

most common organism causing osteomyelitis

A

staph aureus

salmonella in sickle cell anaemia

304
Q

vertebral osteomyelitis

  • common locations
  • symptoms
  • diagnosis/ investigations
  • treatment
A

most common lumbar, then cervical, cervico-thoraco

symptoms- back pain, fever, neuro impairment

diagnosis via MRI, blood cultures.

Tx: 6 wks of antibiotics, longer if undrained abscesses / implant associated.

2nd line- debridement, remove sequestra and infected bone

305
Q

Brodie’s abscess

A

a localized area walled off by fibrous and granulation tissue

intraosseous abscess

occurs in osteomyelitis

306
Q

Chronic osteromyelitis

pain, brodie’s abscess (intraosseous abscess), sinus tract between bone to skin which releases exudates

MRI showing dead bone and new bone (involucrum). Bone biopsy for culture and histology. +ve for bacterial growth.

tx

A

radical debridement down to living bone

remove sequestra (dead bone tissue within diseased bone), infected bone and soft tissue

307
Q

prosthetic joint infection

  • diagnosis
A

radiology - ‘loosening’ bone loss in Xray

if CRP > 13.5 for prosthetic knee infection, CRP >5 for prosthetic hip joint infection

Joint aspiration - for MCS. be careful as there is risk of introducing infection if joint is not already infected

intraoperative microbiological sampling: tissue specimens taken from at least 5 sites around the implant (if 3 or more yield identical organisms, this is highly predictive of infection)

308
Q

treatment of prosthetic joint infection

A

single stage revision:

· Remove all foreign material and dead bone

· Change gloves, drapes etc

· Re-implant new prosthesis with antibiotic impregnated cement and give iv antibiotics.

two stage revision:

Remove prosthesis, take samples for microbiology and histology

Patient given a spacer in place of the prosthesis

· Period of iv Abx (6weeks). Stop Abx for 2 weeks

· Re-debride and sample at second stage

· Re-implantation with Abx-impregnated cement

· No further antibiotics if samples clear

· Involve OPAT

309
Q

Routes of infection in meningitis:

A

Four routes of entry:

haematogenous spread (pneumococcas, herpes)

direct implantation – through surgery

local extension – through the ears from swimming

PNS into CNS – rabies virus at the legs

The most frequent route is haematogenous.

310
Q

infection of the spinal cord, causing a myelitis.

and disturbance of nerve transmission

progressing to paralytic disease. the weakness most often involves the legs, but may also affect the muscles of the head, neck and diaphragm

what organism?

A

Poliovirus

311
Q

neurotoxins causing rigid paralysis

  • what organism?

and

flacid paralysis

  • what organism?
A

clostridium tetani causes rigid paralysis.

c tetani produces a potent biological toxin, tetanospasmin, acting on several sites in the CNS. Causes painful muscular spasms, that can lead to respiratory failure and in some cases, death.

clostridium botulism causes flaccid paralysis

common with canned food

usually descending paralysis

beginning with blurred vision, trouble speaking then weakness of arms, chest, muscles and legs.

312
Q

what pathology lies behind septicaemia?

A

Capillary leak - albumin and other plasma proteins leads to hypovolemia.

Coagulopathy - leads to bleeding and thrombosis. (endothelial injury results in platelet-release reactions, the protein C pathway, plasma anticoagulants)

Metabolic derangement, particularly acidosis

Myocardial failure leading to multi-organ failure

313
Q

most common causes of aseptic meningitis

A

coxsackie group B and echoviruses - 80-90% of cases

herpes simplex

314
Q

what bacterial infection may also cause encephalitis?

A

listeria monocytogenes

315
Q

empiric treatment for meningitis

A

ceftriaxone

if elderly/ immunocomp

+ amoxicillin to cover listeria

316
Q

empiric tx for meningoencephalitis

A

aciclovir

ceftriaxone

if >50/ immuno comp

add amoxicillin

317
Q

why does influenza virus only affect the respiratory tract?

A

Influenza virus infection causes respiratory disease because the influenza virus requires activation by host cell proteases (tryptase) that are only expressed in the respiratory tract.

tryptase cleaves the influenza haemagglutinin

318
Q

ingredients for a pandemic virus:

A

A pandemic virus will have novel antigenicity.

A pandemic virus will replicate efficiently in human airway.

A pandemic virus will transmit efficiently between people. (influenza cannot transmit through air between people hence havent led to pandemics)

319
Q

features of Haemagglutinase and Neuramindase that affect influenza transmission

A

HA and NA are viral surface proteins of influenza

Receptor binding (HA) – able to bind to respiratory cell surfaces

Virion stability – to heat and mildly acidic pH

NA stalk length – able to chew through human mucus to penetrate through the barrier

NA required for release of new virus to propagate infection.

320
Q

what gene mutation is linked with severe influenza?

A

IFITM3

321
Q

what antiviral only works against Influenza A?

A

amantidine

322
Q

which vaccine has dramatically reduced the incidence of meningitis since it was introduced

A

Hib vaccine

323
Q

congenitally transmitted

hepatosplenomegaly, rash, fever, neurosyphilis in the first few years

long-term complications include saddle nose deformity, Higoumenaki’s sign (unilateral enlargement of the clavicle) and Clutton’s joints (symmetrical joint swelling)

A

Syphilis

324
Q

what human herpes viruses are in the alpha subfamily?

what are the characteristics?

A

HSV1, HSV2

VZV

rapid growth + latency in sensory ganglia

325
Q

what human herpes viruses are from the beta subfamily?

What characteristics?

A

CMV, HHV6, HHV7

slow growth

326
Q

what human herpes viruses are from the gamma subfamily?

what characteristics?

A

EBV

HHB8

oncogenic

327
Q

2nd line tx for chicken pox resistant to aciclovir?

A

foscarnet or cidofovir

328
Q

how is aciclovir selective for viral cells?

A

has to be phosphorylated by viral thymidine kinase

affinity to herpesvirus DNA polymerase is 10-30x higher than for cellular DNA

329
Q

tx for herpes simplex encephalitis?

A

aciclovir IV for 21 days

330
Q

CMV presentation in immunosuppressed

A

can cause

pneumonitis, encephalities, retinitis, gastroenteritis, marrow suppression

dx: PCR for viral load

331
Q

tx of CMV infection

A

Ganciclovir IV 1st line

oral valganciclovir - prophylaxis

2nd line: iv foscarnet

3rd line: IV cidofovir

332
Q

Foscarnet

  • how does it work
  • what is it used for
  • side effects
A

non competitive inhibitor of viral DNA polymerase

activity against CMV, occasionally used for HSV e.g. if aciclovir resistant

side effects: nephrotoxic. keep pt well hydrated and monitor electolytes

333
Q

what antiviral may be used to treat RSV in immunocompromised?

A

Ribavarin

Inhibits viral RNA synthesis – broad activity in vitro – effective for Lassa fever and HEV, used in combination with other drugs for HCV

Clinical efficacy for RSV is unclear

334
Q

tx for CMV pneumonitis

A

Ganciclovir + IVIG

335
Q

what is the monoclonal antibody against RSV used prophylactically

A

pavilizumab

in high risk group: preterm, congenital heart/ chronic lung disease, SCID, long term ventilation

336
Q

BK virus

  • what problems does it cause?
A

problematic in the immunocompromised

BMT: haemorrhagic cystitis, less commonly nephritis

Renal transplant: ureteric stenosis, nephritis

tx: bladder washouts for haemorrhagic cystitis

reduce level of immunosupression if possible

IVE cidofovir if significant morbidity

337
Q

Adenovirus

  • what impt group of patients does this virus affect?
  • tx?
A

Paediatric post BMT patients

causes fever, encephalitis, pneumonitis, colitis, haemorrhagic cystitis

do weekyly PCR surveillance

Tx: reduce immunosuppression

+ IV cidofovir 1st line

338
Q

hep B tx

A

combined antiviral + immunomodulatory effect:

IFNa or PefIFNa-2a

= nucleoside/nucleotide RTI - lamivudine, tenofovir

339
Q

Tx for EBV driven PTLD

post transplant lymphoproliferative disease

A

rituximab anti-CD20

340
Q

uncomplicated vs complicated UTI? whats the difference?

A

· Uncomplicated UTI refers to infection in a structurally and neurologically normal urinary tract.

· Complicated UTI refers to infection in a urinary tract with functional or structural abnormalities (including indwelling catheters and calculi).

341
Q

causes of sterile pyuria

A

· Prior treatment with antibiotics, catheterisation

· Calculi, bladder neoplasm, TB

· Sexually Transmitted Disease – gonorrhoea and chlamydia won’t grow on typical agar used.

342
Q

1st line treatment for UTI (imperial guidelines)

A

due to resistance to trimethoprim.

1st line cefalexin for 7 days

for men, women, breastfeeding

343
Q

tx for pyelonephritis or urosepsis

A

IV co-amoxiclav

+ amikacin/ gentamicin

344
Q

what is herd immunity

A

· Form of immunity that occurs when vaccination of a significant proportion of a population provides a measure of protection for individuals that are not immune.

345
Q

advantages & disadvantages of live vaccines

A

Single dose often sufficient to induce long-lasting immunity, strong immune response evoked, local and systemic immunity produced

Disadvantages:

· Potential to revert to virulence, poor stability

· Contraindicated in immunosuppressed patients

· Interference by viruses or vaccines and passive antibody, p otential for contamination

346
Q

advantages and disadvantages of inactivated vaccines

A

Advantages: Stable, constituents clearly defined, unable to cause the infection

Disadvantages:

· Need several doses, local reactions common

· Adjuvant needed tokeep vaccine at injection site and activate APCs, shorter lasting immunity

347
Q

established risk of measles vaccine

A

thrombocytopenia

348
Q

established risk of rubella vaccine

A

acute arthritis

349
Q

prerequisites for successful disease eradication

A

· No animal reservoir

· Antigenically stable pathogen with only one (or small number of) strains

· No latent reservoir of infection and no integration of pathogen genetic material into host genome

· Vaccine must induce a lasting and effective immune response. High coverage required for very contagious pathogens

350
Q

mycobacterium leprae

  • what condition
A

leprosy aka hansen’s disease

incubation 2-10 yrs

symptoms that develop include granulomas of the nerves, resp tract, skin and eyes.

may result in lack of ability to feel pain, thus loss of parts of extremities due to repeated infections due to unnoticed wounds/ injuries

weakness/ poor eyesight

split into paucibacillary (<5) and multibacillary (>5 poorly pigmented, numb skin patches)

dx by skin biopsy showing acid fast bacilli or PCR

tx involves dapsone and rifampicin for 6 months

+ clofazimine (for multibacillary- all 3 for 12 months)

*dapsone causes oxidant damage in G6PD deficiency

351
Q

multidrug resistant TB -resistant to?

A

rifampicin + isoniazid

352
Q

Extremely drug resistant TB

resistant to?

A

rifampicin, isoniazid

+ at least 1 injectable

and fluoroquinolones

353
Q

CMV in pregnancy tx

A

none

· If maternal CMV infection suspected check serology (compare with booking bloods)

· If suspected seroconversion during pregnancy refer to fetal medicine unit for USS +/- amnio

354
Q

measles in pregnancy

causes?

A

o Fetal loss (miscarriage, IUD), preterm delivery

o Increased maternal morbidity

o No congenital abnormalities to fetus

355
Q

parvovirus B19 in pregnancy- results in?

A

o 9% risk of infection overall

o 3% risk of hydrops fetalis (oedema) if infection from 9-20/40

o Risk of fetal anomalies less than 1%

Maternal infection after 20/40 – no risk

mx:

· Refer to fetal medicine for monitoring

· Intrauterine transfusion improves fetal outcome

356
Q

coxsackie virus (hand foot mouth disease) in pregnancy:

A

o early onset neonatal hepatitis, congenital myocarditis, early onset childhood IDDM, & abortion or intrauterine death

357
Q

zika virus in pregnancy: consequences

A

· Miscarriage/stillbirth/microcephaly

congenital zika syndrome:

· Severe microcephaly + skull deformity

· Decreased brain tissue, seizures, hypertonia

· Retinopathy, deafness, talipes

358
Q

what are some AIDS-defining illnesses?

A

· Cervical cancer, invasive

· CMV disease (other than liver, spleen, or nodes)

· Cytomegalovirus retinitis (with loss of vision)

· Encephalopathy, HIV related

· HSV: chronic ulcer(s) (>1 month in duration); or bronchitis, pneumonitis, or esophagitis

· EBV: severe candidiasis, hairy oral leukoplakia

· Kaposi sarcoma

· Lymphoma, Burkitt’s (or equivalent term)

Progressive multifocal leukoencephalopathy - JC

359
Q

what cells do CMV and HHV6 infect?

A

stay in lymphocytes

360
Q

VZV infection in immunocompromised: complications

A

o Pneumonitis, encephalitis, hepatitis

o Purpura fulminans in neonate

o Shingles-often late complication post-transplant

· Shingles can be early sign of HIV infection-indicate HIV testing particularly in young person

· Multidermatomal or disseminated zoster (signs of losing control) is associated with high mortality, need quite aggressive treatment

· Acute retinal necrosis (ARN)

· Progressive outer retinal necrosis (PORN)

· VZV-associated vasculopathy

361
Q

Post transplant prophylaxis measures to reduce opportunistic viral infection/ reactivation:

A

Aciclovir for HSV and VZV

Ganciclovir - but this causes BM suppression so avoid in BM transplant pt.

Valganciclovir (100 days) for CMV in a solid organ transplant pt

362
Q

post transplant lymphoproliferative disease

A

latently infected B cells (EBV) - polyclonal activation

predisposes to lymphoma

suspicion on rising EBV viral load and CT scan

confirmation w biopsy of LNs

mx: reduce immunosuppression

antiCD20 rituximab

363
Q

progressive multifocal leukoencephalopathy

what virus?

A

JC virus

364
Q

Progressive multifocal leukoencephalopathy

JC virus

A

seen in immunosuppressed hosts

· Cognitive disturbance, personality change, motor deficits other focal neurological signs

· The main pathological feature of PML is a demyelination of white matter with neurological deficits corresponding to the area(s) of the brain affected.

Diagnosis: MRI and PCR on CSF

365
Q

BK cystitis

A

BK virus

Risk of BK cystitis post SCT and BK nephropathy post Renal Tx

· Present with fever, cystitis, haematuria

· Tx: bladder irrigation, modulation of immunosuppression with cidofovir

366
Q

tx of influenza A and B

A

oseltamivir for 5 days

if severely immunosuppressed: IV zanamivir

367
Q

congenital toxoplasmosis

A

· May be asymptomatic at birth – 60% but may still go on to suffer long term sequelae – deafness, low IQ, microcephaly

· 40% symptomatic at birth: choroidoretinitis; microcephaly/hydrocephalus; intracranial calcification; seizures; jaundice; hepatosplenomegaly

368
Q

risk factors for early onset sepsis in neonate;

A

Maternal: PROM/prem. labour (increased risk of ascending infection before labour due to early rupture of membrane), fever, foetal distress. meconium staining, previous history

Baby: Birth asphyxia, resp. distress, low BP, acidosis, hypoglycaemia (good marker for sepsis), neutropenia, thrombocytopenia, rash, hepatosplenomegaly, jaundice

369
Q

tx of early onset neonatal sepsis

A

Supportive: ventilation, circulation, nutrition – TPN

· Antibiotics: e.g. benzylpenicillin for GBS & gentamicin for E. coli (also consider Listeria)

370
Q

late onset sepsis- after 48h of birth tx

o 1st line: Flucloxacillin & gentamicin

o 2ndline: Pipericillin/tazobactam & vancomycin

o Community acquired late onset infections: cefotaxime, amoxicillin +/-gentamicin

A

o 1st line: Flucloxacillin & gentamicin

o 2ndline: Pipericillin/tazobactam & vancomycin

o Community acquired late onset infections: cefotaxime, amoxicillin +/-gentamicin

371
Q

what are some risk factors for infective endocarditis?

A

rheumatic fever

structural heart disease

prosthetic valves

poor dentition

Bowel/ GI problem - diverticular, bowel lesion

lines, esp long term

· Prior bactereamias, especially Staphylococcus aureus, enterococcus, rare gram negatives

372
Q

signs of Infective endocarditis

A

Heart murmur 85%, changing murmur 5-10%, embolic lesions >50%, osler’s 10-23%, splinter haemorrhages 15%, splenomegaly 20-57%, clubbing 10-20%, PR interval on ECG

373
Q

what are some symptoms of Infective endocarditis?

A

Fever 80%, chills 40%, weakness 40%, dyspnoea 40%, weight loss

374
Q

complications of Infective endocarditis

A

splenic infarcts 44%, cerebral abscesses 20%, glomerulonephritis (look for blood in urine dipstick!)

375
Q

most common valve affected in IVDU endocarditis

A

tricuspid valve

most common s aureus

most common in IVDU w HIV

polymicrobial infection is more common

376
Q

most common group of pathogens causing infective endocarditis

A

strep viridans

e.g. strep oralis, strep bovis

377
Q

Organisms that may be found on Prosthetic valve endocarditis

A

CNS (staph epidermiditis), staph aureus

378
Q

Culture negative endocarditis?

A

Most commonly due to cultures taken afterantibiotics!

Brucella, coxiella, chlamydia, mycoplasma, bartonella, HACEK organisms

379
Q

investigations for infective endocarditis

A

· Multiple blood cultures: at least 3 blood cultures in the first 24hrs off antibiotics

· Echo and ECG (?carditis), FBC (anaemia), ESR (usually raised), CRP ( useful to monitor therapy)

· Serology if culture negative - brucella, bartonella, chlamydia, coxiella

Dukes criteria

380
Q

dukes criteria for Infective endocarditis

A

clinical criteria- 2 major criteria/ 1 major and 3 minor criteria/ 5 minor criteria

Major criteria: Positive Blood culture for IE (a typical microorganism consistent with IE), evidence of endocardial involvement (echo, new valvular regurgitation)

Minor criteria:

o Predisposing heart condition or iv drug use

o Fever > 38ºC

o Vascular phenomena: major arterial emboli, septic pulmonary infarcts etc

o Immunological phenomena eg. oslers nodes, glomerulonephritis, janeway lesions

o Microbiological evidence: positive blood culture but does not meet a major criterion

o Echo findings consistent with endocarditis but do not meet major criterion

381
Q

tx of strep viridans endocarditis

A

benzylpenicillin and gentamicin

382
Q

tx of enterococcal endocarditis

A

ampicillin and gentamicin

383
Q

tx of MSSA endocarditis

A

flucloxacillin for 4-6 wks at least

384
Q

tx for MRSA endocarditis

A

vancomycin and gentamicin or rifampicin or fucidin

385
Q

indications for surgical therapy in Infective endocarditis

A

· More than 1 serious systemic emboli

· Uncontrolled infection

· Significant valve dysfunction

· Lack of response to antibiotics

· Local suppurative complications e.g perivalvular abscesses

· Congestive heart failure

386
Q

diagnosis of brucellosis

A

culture of Bone marrow (>90% positive)

blood cultures (70% +ve)

serological diagnostic tests

387
Q

tx of brucellosis

A

4-6 wks of doxycycline + IM streptomycin

or

Oral doxycycline and rifampicin

388
Q

louse borne relapsing fever

fever, rigors, headache, myalgia

A

transmitted by body louse

mortality rate is 30-70% without treatment. 1% w treatment

occurs in epidemics amid poor living conditions, famine and war in the developing world

pathogens: rickettsia prowazekii

389
Q

tonsillar biopsy for variant CJD

what is seen?

A

florid plaques and vacuolation

390
Q

diagnostic test for Hep C

A

HCV RNA
Anti-HCV antibodies - if immunocompromised, may not even develop antibodies

391
Q

severe falciparum tx

A

medical emergency

· WHO 1stline: - IV Artesunate: BM monitoring, better tolerated, more rapid clearance of parasitaemia,

· IV Quinine, arrhythmogenic and causes hypoglycaemia, require cardiac & BM monitoring

392
Q

what does mycobacterium tuberculosis look like on lowenstein-jensen medium?

A

appears as brown coffee-colored (buff), granular bread crumb-like colonies (rough) which often stick to the bottom of the growth plate are are hard to remove (tough)
‘buff, rough and tough’.

393
Q

how does mycobacteria tuberculous appear on the ziehl-neelson stain?

A

bright red against a blue background.

the stain contains carbofuchsin, a pink dye which binds to the unique mycolic acids found in the mycobacterium cell wall

394
Q

how does mycobacterium tb or other acid fast bacilli

appear on auramine stain

A

yellow fluorescence

395
Q

acid fast bacilli on skin biospy/ nasal smear

hypopigmented skin lesions, nodules and loss of sensation

what condition

and what organism?

A

mycobacterium leprae

396
Q

Coxiella burnetti- Q fever

A

first described by abbatoir workers

obligate intracellular gram - bacteria found in animals and pets

manifests as flu like symptoms but can progress to atypical pneumonia or less often a granulomatous hepatitis.

typical CXR- ground glass appearance

397
Q

Mantoux test results:

when is an induration of 5mm or more considered positive

A

HIV pts, recent contact with TB, ppl w fibrotic changes on CXR consistent w prior TB, pts w organ transplants, ppl who are immunosuppressed

398
Q

Mantoux test

when is an induration of 10mm or more considered positive

A

recent immigrants (<5 yrs) from high prevalence countries

IVDU

residents and employees of high-risk congregate settings

mycobacteriology laboratory personnel

persons w clinical conditions that place them at high risk

children <4 yrs of age

infants, children, adolescents exposed to adults in high-risk categories

399
Q

Mantoux test

when is an induration of >15mm considered positive

A

considered positive in any person, including those with no known risk factors for TB

400
Q

what are the alpha haemolytic streptococci?

how do you differentiate the two?

A

strep pneumoniae

strep viridans

s. pneumoniae is optochin sensitive

and

s viridans is optochin resistant

401
Q

what are some beta haemolytic streptococci?

A

Group A Strep

e.g. strep pyogenes

scarlet fever, strep throat, impetigo, rheumatic fever, post strep glomerulonephritis

Group B Strep

e.g. in O&G

groups C/D/E etc

402
Q

gram -ve rod

atypical pneumonia

frequently in alcoholics

can result in sudden, v severe systemic upset in these patients, and the production of thick, purulent, and sometimes blood stained sputum said to resemble redcurrant jelly

A

klebsiella pneumoniae

haemoptysis occurs most frequently with this organism

radiological features include upper lobe consolidation, w marked cavitation as described in the question.

it is more likely to lead to complications such as lung abscesses and empyemas than pneumonias caused by strep penumoniae

403
Q

subacute infective endocarditis most common cause

A

strep viridans

+ usually on damaged valves

insidious onset of fever, night sweats and weight loss

404
Q

signs of infective endocarditis?

A

hand: clubbing, splinter haemorrhages
abdomen: splenomegaly, microscopic haematuria

new or changing heart murmurs

eponymous signs: Oslers nodes (immune complex deposition), janeway lesions (septic emboli which deposit bacteria, forming microabscesses), roth spots (immune complex mediated vasculitis)

405
Q

strep bovis infective endocarditis - assoc w?

A

colonic malignancy

  • must do a colonoscopy
406
Q

what is the active form of acyclovir ?

A

acyclovir triphosphate

acyclovir -> acyclovir-monophosphate by viral thymidine kinase

acyclovir-monophosphate-> di -> triphosphate by cellular tyhymide kinase

407
Q

why is e coli so good at causing UTI?

A

a flagellum enabling it to move upstream

fimbriae so that it can adhere to the urothelium

haemolysin to form pores in WBCs

it also has a protective capsure called the K antigen

408
Q

proteus mirabilis UTI predisposes to what complication

A

formation of phosphate stones, particularly staghorn calculi

409
Q

entamoeba histolytic memory aid

four runners ent-ering a race and the winner gets a silver flask

A

entamoeba cysts classically have four nuclei

entamoeba

flask shaped ulcers

410
Q

mnemonic for important oxidast positive organisms

PuNCH Me Very Lightly

A

Pseudomona

Neisseria

Campylobacter

Helicobacter

Moraxella

Vibrio

Legionellaa

411
Q

Visceral leishmaniasis

aka
Kala Azar

  • clinical features?
A

Fever, splenomegaly

Hepatomegaly, skin hyperpigmentation and dry warty skin

bone marrow invasion can result in pancytopenia

transmitted by phlebotomine sandflies and occurs in africa, america and the middle east

leishmania donovani and l infantum

412
Q

cutaneous leishmaniasis

features

A

most common form of leishmaniasis is cutaneous

itchy papule develops at bite site and develops into an ulcer with raised edges

local LNpathy can also occur

but the lesion usually heals within 8 months leaving a depigmented scar

l. major and l. tropica.

diagnosis by giemsa staining of skin smears

cultured on novy-macneal-nicolle medium

1st line drug - pentavalent antimonial such as sodium stibogluconate

413
Q

mucocutaneous leishmaniasis

  • features
A

the most feared form of cutaneous leishmaniasis

can produce destructive and disfiguring facial lesions

may begin as the cutaneous form but years later ulceration can appear in mucous membranes leading to mutilation of those areas

most often caused by leishmania braziliensis.

414
Q

toxoplasmosis

A

toxoplasma gondii

can infect humans by eating undercooked meat or from contact w cat faeces

trophozites in the gut and spread to brain, eyes and lungs

in AIDs pts it can have neurological manifestations such as cranial n palsies, meningo-encephalitis and focal neuro deficits secondary to space occupying lesion

in the eye- chorioretinitis

CT scan shows ring enhancing lesions w surrounding oedmea

tOxOplasmosis - rmb the rings on the CT scan

415
Q

vector for lyme disease

A

Ixodes tick

416
Q

Lyme disease memory aid

PEACH

A

Peripheral neuropathy

Erythema chronicum migrans

Arthritis

Cranial n palsies

Heart block

late stage - persistent arthritis and chronic encephalitis

417
Q

what rash is assoc w rheumatic fever

A

erythema marginatum

418
Q

tx of neisseria gonorrhoea septic arthritis

A

IV cefotaxime for 4-6 wks

419
Q

HBsAg +ve after 6 months - what are you?

A

hepatitis carrier

420
Q

Anti-HBs Ab

+ve

what does this mean

A

IgG antibody that appears after the host has cleared the infection and indicates recovery

also +ve in those who have been vaccinated

421
Q

HBeAg +ve

what does this mean

A

found when virus is actively replicating

e for EEK

highly infective!!

422
Q

Anti-HbC IgM

what does this mean

A

patient has been recently infected w hep B

and is a marker of acute infection

423
Q

Anti-HBc IgG +ve

what does this mean

A

core antigen- for chronicity

has been infected before

if HBsAg -ve and HbsAb +ve then this person would be immune from natural infection

424
Q

if someone has had C difficile pseudomembranous colitis before and been treated and presents again, what tx?

A

repeat course of metronidazole for 10-14 days for trx of recurrent c difficile infection

425
Q

which antibiotic may cause red man syndrome

A

vancomycin

sudden onset erythematour pruritic rash over face, neck and upper torso

rmb driver of red cross van emerging very angry w bright red face

426
Q

sporadic CJD memory aid

demented LAMB

A

dementia - v rapid

LMN signs

Akinetic mutism

Myoclonus

cortical Blindness

427
Q

in variant CJD what do u see in MRI

A

positive pulvinar sign (enhanced signal of nuclei in the thalamus)

428
Q

BG of portal hypertension and chronic liver disease

fever, tachycardia, abdo tenderness and ascites

nausea vomiting, general malaise or features of hepatic encephalopathy

what condition?

how to diagnose?

A

spontaneous bacterial peritonitis

diagnostic paracentesis: ascitic fluid WCC / neutrophil count

most common organisms in SBP are e coli, gram + cococi and enterococci

tx: cefotaxime

429
Q

with Hep C, what determines how likely someone is to cleart he virus?

A

virus strain/ genotype

genotype 1 assoc w poorer response to anti viral (IFN and ribavarin)

430
Q
A
431
Q

Human African trypanosomiasis aka Sleeping Sickness

-an infection transmitted by the tsetse fly

A

two main types:

1) trypanosoma brucei gambiense - responsible for >95% of cases. causes chronic infection that takes months-years to appear.

Gambiense for gradual

2) trypanosoma brucei rhodesiense - <5% causes acute infection, appearing over wks-months

Rhodesiense for rapid infection

A subcutaneous chancre can develop at the site where the tsetse fly bites and symptoms such as fevers, weakness, arthralgia and headache can then appear. + posterior cervical lymphadenopathy (winterbottom’s sign)

Later the parasite crosses the BBB to cause disturbance of the sleep cycle, ataxia, behavioural changes and psychiatric disturbance.

Tx is w drugs such as pentamidine and suramin in early stages

432
Q

Sleeping sickness-

organism responsible for a rapid infection

occuring over a few wks or months

A

trypanosoma brucei rhodesiense

  • fevers, weakness, arthralgia, headache

posterior cervical lymphadenopathy

disturbance of sleep cycle, ataxia, behavioural changes, psychiatric disturbance

433
Q

sleeping sickness

what organism is responsible for majority of the infections.

and causes a chronic infection

showing up months - years later

A

Trypanosoma brucei gambiense

  • fevers, weakness, arthralgia, headache

posterior cervical lymphadenopathy

disturbance of sleep cycle, ataxia, behavioural changes, psychiatric disturbance

434
Q

what vector transmits the sleeping sickness? (trypanosoma)

A

tsetse fly

435
Q

Chagas Disease

carried by the reduviid bug

  • what presentation
A

trypanosoma cruzi

‘kissing bugs’ aka reduviid bugs

a red nodule, called a chagoma, can appear at the site of the bite

acute phase: fever, lethargy, diarrhoea and vomiting. characteristic feature is a purplish swelling of the eyelids (called Romana’s sign)

to put this all together, picture Tom Cruise (Trypanosoma cruzi) starring in a gladiator film as a roman (romana’s sign) wearing purple sunglasses (swollen eyelids) and being kissed (kisisng bugs) by lots of fans ‘ready w their video cameras’ (reduviid bug)

436
Q

Chagas Disease

trypanosoma cruzi (Tom Cruise)

spread by reduviid bugs

what does the chronic phase present w?

A

can occur years after the initial bite, and typically affects the heart and GI tract.

Both dilation and dysfunction in three organs:

heart (dilated cardiomyopathy and arrhythmias)

colon (megacolon and constipation)

oesophagus (megaoesophagus and dysphagia)

Tx: bennzimidazole and nifurtimox

437
Q

what vector transmits dengue fever

A

Aedes mosquito

438
Q

Maurer’s clefts on Malaria thin blood film

A

Plasmodium falciparum

these are disc-like granulations seen at the edge of the cell using an electron microscope.

they are larger and coarser than the Schuffner’s dots seen w P vivax and P ovale.

439
Q

Schuffner’s dots on thin blood film

A

P ovale and P vivax

these are punctuate granulations seen under the microscope in erythrocytes invaded by the tertian malaria parasite

440
Q

Severe malaria tx?

V severe malaria?

A

IV Quinine

if v severe: IV artesunate +/- IV quinine

441
Q

tx of uncomplicated malaria

A

ALWAYS ADMIT

Oral quinine and doxycycline for 5-7 days

Co-artem (artemetherelumefantrine) for 3 days

Malarone (atovaquone-proguanil) for 3 days

442
Q

tx of non-falciparum malaria

A

chloroquine + 2 wks of primaquine

chloroquine to treat the parasites in the erythrocytes and primaquine to kill the hypnozoites that remain latent in the liver

443
Q

malaria life cycle

an infected mosquito injects ______ from its saliva into a persons blood stream when it bites

A

sporozites

444
Q

malaria life cycle

sporozites enter the blood stream where they are taken to the ____ where they infect _____

A

liver

hepatocytes

445
Q

Malaria life cycle

In the liver, they multiply for a varying period of time, and then differentiate to form haploid ______. These have a ‘signet ring’ appearance

______ are oval-shaped inclusions that contain the ______.

A

Haploid merozites

shizonts are oval shaped inclusions that contain the merozoites.

*P vivax and P ovale sporozites may not develop into merozites immediately, but can form hypnozoites that remain dormant in the liver

446
Q

P vivax and P ovale sporozites may not develop into merozites immediately, but can form ______ that remain dormant in the liver

A

hypnozoites

447
Q

malaria life cycle

merozites escape from the liver into the blood stream and infect RBCs.

they multiply further in the erythrocytes and will be released from them at intervals. the waves of fever the patient experiences correspond to when the merozites are released from the erythrocytes.

some of the merozoites develop into sexual forms of the parasite called _________ which can be taken up by the next mosquito.

A

male and female gametocytes

448
Q

what malaria parasite causes daily (quotidian) fevers

A

Plasmodium knowlesi

mainly occus in SEA, and not in africa

449
Q

side effects of ethambutol

A

renal impairment (avoid in pts w impaired renal fn)

pts renal function should be checked routinely before

ocular toxicity

  • changes in visual acuity, colour blindness and restriction of visual fields
450
Q

why should liver function be tested in everyone before starting antituberculous therapy?

A

isoniazid, rifampicin and pyrazinamide are all hepatotoxic

Rifampicin can commonly cause a transient disturbance to LFTs for the first 2 months, but this does not usually necessitate any changes to the tx regimen.

451
Q

gram -ve diplococci

pneumonia

esp in smokers

chronic lung disease

and causes exacerbations of COPD

other targets of infection include ears, eyes and CNS

A

moraxella catarrhalis

452
Q

what causes threadworm infection?

A

roundworm - enterobius vermicularis

453
Q

presentation of hydatid disease

A

tapewarm causing cysts in liver, lungs

abdo discomfort, biliary obstruction or incidental finding on USS

cyst rupture may result in anaphylaxis

454
Q

hydatid disease

what organism

A

tapeworm

echinococcus granulosus

455
Q

mx of hydatid disease

A

long term albendazole/ praziquantel

PAIR (puncture-aspirate-injection-reaspirate) for inoperable cysts

surgical removal of cysts

456
Q

Ascariasis

presentation

A

large roundworms, growing up to 35cm

symptoms when worm burden is high - bloody sputum, cough, fever, abdo discomfort, intestinal ulcer, passing worms

sometimes see TONS of worms in intestine

457
Q

mx of ascariasis

A

albendazole.

keep NMB, natural peristalsis usually expels worms

may need surgery - if bowel obstruction.

458
Q

itchy migrating painful rash on foot

hx involves barefoot walking on beach

A

cutaneous larva migrans

hook worm

heals spontaneously over weeks to months

cant get beyond the subcut tissues

459
Q

mx of cutaneous larva migrans

A

oral albendazole/ Ivermectin can speed up process

topical / oral thiabendazole halts migration of larva/ relieves itching in <48h

460
Q

strongyloides

usual presentation

A

asymptomatic

or mild GI symptoms/ skin rash (larva currens)

can be lifelong infection

diagnosis via stool/ serology

461
Q

strongyloides

severe presentation

A

strongyloides hyperinfestation syndrome

when immune system fails

e.g. steroids/ biologics

bowel breakdown -> gram - bacteraemia

-> CNS meningitis, encephalitis, lung disease, death

462
Q

mx of strongyloides

A

Ivermectin x2

463
Q

schistosomiasis mx

A

praziquantel

464
Q

water snails vector

causes eosinophilia, haematuria, Katayama fever (cough, wheeze, urticaria, eosinophilia)

A

schistosomiasis

migrates via lungs (causing Katayama fever)

colonises colon, bladder, liver

complications: bladder SCC, portal HTN

465
Q

diagnosis of schistosomiasis

A

egg microscopy

serology

466
Q

what vectors for leishmaniasis?

A

sandflies

467
Q

what is the vector for trypanosomiasis

A

tsetse flies

468
Q

trypanosomiasis

presentation

aka chagas disease

A

red chancre

aggressive fulminant infection:

fever, swollen LNs, bloody urine, myalgia, headache, irritability and death

also causes sleeping sickness: presents months to years later

Tom cruise: trypanosoma cruzi

469
Q

loa loa presentation

A

conjunctiva of the eye

eye worm

  • visual disturbance

calabar swellings

dx: seeing the worm, blood film for microfilariae

470
Q

GI infection- watery diarrhoea, abdo cramps

fever, headaches

unpasteurized dairy products

tumbling motility

A

listeria monocytogenes

471
Q

profuse watery diarrhoea

no inflammatory cells on microscopy

A

vibrio cholera

active secretion of NaCl

water lost due to osmotic pull of NaCl

472
Q

fever, constipation, splenomegaly

rose spots

A

salmonella typhi

enteric fever

multiplies in Peyers patches of Small intestine

473
Q

flask shaped ulcers

dysentery

chronic weight loss

liver abscess

A

entamoeba histolytic

motile trophozite

-> colonization of colon and caecum

474
Q

26 yr old man has recently returned to the UK from a year of working in Africa where he was taking part in a charity farming project.

he presents to A+E with signs of meningism.

a serological microscopic agglutination test is positive

A

Leptospirosis (weils syndrome)

A microscopic agglutination test is gold standard for diagnosis

475
Q

most common cause of viral meningitis

of the herpes family

A

herpes simplex type 2

type 1 - encephalitis more common

476
Q

what organism causes donovanosis

A

klebsiella granulomatis

gram + rod

477
Q

pegylated-IFNa

how is it different from IFNa

A

addition of polyethylene glycol - increases the half life of the drug

used in tx of Hep C

IFNa acts on the JAK-STAT pathway

478
Q

a 48 yr old man presents to his GP with flu like symptoms

OE the pt has a maculopapular rash on his trunk

the patient also shows an area where a vague bite mark is visible

A

rocky mountain spotted fever

caused by Rickettsia infection

harboured in small wild rodents and domestic animals.

-> rickettsia bacteria cause vasculitis

features include headache, fever, myalgia, vomiting, confusion

late signs: rash maculopapular/ petechial

RMSF may lead to hypoNa, thrombocytopenia and elevated liver enzymes

479
Q

congenital syphilis symptoms/signs

A

hepatosplenomegaly, rash, fever, neurosyphilis.

later on- saddle nose deformity, higoumenaki’s sign (unilateral enlargement of the clavicle) and Cluttons joints

480
Q

response to antiviral tx depends on viral genotype

Hepatitis C:

what genotypes are associated w poorer response.

A

genotype 1 poor response.

genotype 2 /3 better response so only need 24 weeks

path (6 decks)

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