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MKSAP Flashcards

1
Q

Which RIPE Tb drug can cause hyperuricaemia ?

A

Pyrixinamide. Contraindicated in active hour - caution in chronic gout. Also causes hepatitis and GI upset

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2
Q

Blastomycosis

A

Yeast。 up to 40% get extra pulmonary manifestation e.g skin lesion. Use itraconazole if mild. Amphterocin if severe pulmonary disseminated disease

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3
Q

Tuberculous pericarditis?

A

Prednisone + RIPE

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4
Q

Treatment of cervicitis?

A

Single ceftriaxone and doxycycline for 14 days

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5
Q

Toxoplamosis? Findings on MRI?

A

Ring enhancing lesions in immunocompromised AIDS patients CD4 <100. Use pyrimethamine & sulfadiazine. If no improvement in 2 weeeks involve neurosx for biopsy

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6
Q

HIV/AIDS CD4 166 with fever headache. CT mildly increased ventricular size

A

Cryptocccus neoformans = amphotericin B followed by long term oral fluconazole.

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7
Q

CMV encephalitis CD count threshhold?

A

<100. MRI shows periventricular involvement

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8
Q

Tacrolimus toxicity

A

Acute rise in creatinine and urea. Hypertension, hyperglycaemia, hyperkalaemia, hypomagnesaemia. Increased toxicity with macrolide
Tremors

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9
Q

Vibrio Vilnius is

A

Can cause necrotising fasciitis - exposure to shellfish in warm months Gulf of Mexico. Haemachromatosis patients more susceptible

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10
Q

Capnocytophaga canimorsus

A

Gram-negative rod causing overwhelming sepsis in cat /dog bite - particularly asplenic patients

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11
Q

Cat scratch

A 
Bartonella henslae. 
Azithromycin 
Doxycycline
Bactrim 
Ciprofloxacin
Clarithryomycin
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12
Q

Cat bite

A

Pastuerella.

Consider augmentin or clindamycin

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13
Q

Preventing varicella infection in immunocompromised

A

Varicella immunoglobulin. Cannot do live vaccine

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14
Q

Best screen TB in patient with BCG vaccine?

A

IGRA

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15
Q

Shigella

A

Ciprofloxacin

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16
Q

Campylobacter

A

Azithromycin

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17
Q

Life threatening candidaemia

A

Echinocandin agent - anidulafungin, caspofungin, micafungin

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18
Q

Blastocystis diarrhoea

A

Treat with metronidazole or Bactrim. If asymptomatic no requirement to treat

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19
Q

Cavitatitory CAP severe

A

Ceftriaxone, azithromycin + additional vanc due to cavitation

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20
Q

Botulism

A

Foodborne transmission
1-5 days onset. Symmetric descending flaccid paralysis prominent bulbar palsy, normal GCS. Afebrile.
4Ds - diplopia, dysarthria, dysphonia, dysphagia

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21
Q

Paralytic shellfish poisoning

A

Tingling of lips and tongue - parathesia of hands & feet

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22
Q

Oesophageal candidiasis

A

Fluconazole oral. Prophylaxis if CD count <100

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23
Q

Empiric treatment of life threatening diabetic osteomyelitis

A

Meropenem and vancomycin

Bone biopsy most sensitive - MRI not definitive and growth on swabs no reliable unless staph a

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24
Q

HIV pregnancy

A

Behind ART regardless of CD 4 count, viral load, or symptoms. Zidovudine, lamivudine, lopinavir-ritonavir safe in pregnancy.
Efavirenz is contraindicated in pregnant

25
Fever, headache, myalgia, lower back pain, rash on trunk + lower extremities, thrombocytopenia
``` Dengue fever Break bone fever Frontal and retro-orbital pain Rash sparing palms and soles Neutropenia Thrombocytopenia AST>ALT ``` Aedes aegypti mosquito
26
Interpret TST in IVDU
If<10mm = negative High risk groups who need CXR include HIV, evidence of old TB, contact with active TB, organ transplant, immunosuppressed
27
CMV rejection
Fevers, myalgia, hepatitis Valganciclovor oral or IV ganciclovir Or foscarnet Can give cytotoxic T lymphocytes
28
BK virus
Late term complication of kidney transplant. Nephropathy, organ rejection, urethral strictures. Decoy cells in urine Mx: reduce inmunsuppression
29
EBV PTLD
Reduce immunosuppression | In severe disease, also give rituximab
30
Gram negative rod respiratory
Pseudomonas auruginosa Cefepime/mero/tazocin Plus ciprofloxacin/levofloxacin Or beta lactam + aminoglycoside + azithromycin Aztreonam alternative antipseudomonal agent for severe beta lactam allergy
31
HSV encephalitis
IV aciclovir as oral does not give good brain penetration for 14-21 days. MRI 90% abnormal - temporal lobe inflammation. If negative CSF HSV PCR and normal MRI brain, cease IV aciclovir.
32
PCP
Dry cough; dyspnoea. CXR diffuse interstitial disease in immunocompromised. Treat with bactrim. If pO2 < 70, add prednisone
33
Mucormycosis
Sinusitis, rhino-orbital infection , Black eschar Need to debride and use IV amphotericin B. Step down to posaconazole.
34
HIV treatment failure
Remain in treatment whilst doing resistance testing. No role in stopping ART
35
Bipolar gran negative bacillus
Closed safety pin appearance - yersinia pestis | Bubonic plague!
36
Typhoid fever
Rose colored rash, diarrhoea, abdominal pain Thrombocytopenia, leucopenia, raised bilirubin Vaccine not completely effective
37
Leishmaniasis
Protozoal disease, female sandfly vector | Hypergammaglobulinemia, weight loss, fever, hepatosplenomegaly
38
Brucellosis
Zoonotic , fever, bone pain, joint pain neuro
39
Gonorrhoea
Intracellular gram negative diplococci | Ceftriaxone and azithromycin
40
Allergic diseases
C1 inhibitor deficiency - recurrent angioedena, family hx (AD), abdo pain, laryngeal oedema Selective IgA deficiency - chronic LRTI, autoimmune & atopic disorder, gastrointestinal and uti post blood transfusion Terminal C5-9 deficiency - autosomal co dominant - susceptible to neisseria meningococcal disease
41
Which abx not effective in pneumonia ?
Daptomycin | Keflex
42
Which drug cannot be used as mono therapy due to resistance?
Rifampicin
43
Which malaria prophylaxis good for pregnant women?
Mefloquine. Chloroquine not used because of high resistance rates Doxycycline and atovoquone-proguanil not good for pregnancy
44
Which prophylaxis most effective against travelers diarrhoea in IBD on immunosuppresion?
Rifaxamin
45
Familial Mediterranean fever
Recurrent fevers. Joint pain, rash on lower torso, usually manifests <20 Neutrophilix leucocytosis
46
Sweets syndrome
Erythrodermic neutrophilic leucocytosis. Usually on face, arms and chest. Can be associated with haem malignancy
47
Foul smelling diarrhoea with bloating
Giardia
48
Syphillis
Primary - chancre Secondary Tertiary neurosyphillis Single IM penicillin G
49
Risk of cyclosporine toxicity ?
Itraconazole, voriconazole. Not fluconazole. Features are hirsutism, gingival hyperplasia
50
Adenovirus
Cidofivir
51
``` Which of the following findings would virtually exclude a partially treated bacterial meningitis? A. negative gram stain B. negative culture C. CSF glucose 45% of serum glucose D. Negative Kernigs E. CSF WCC 3 ```
E. A CSF white count of 3 (normal) makes bacterial meningitis extremely unlikely
52
Management of tetanus?
Prior to wound debridement, it is crucial to give human tetanus immunoglobulin. This is because of the risk that debridement may precipitate further release of tetanus toxin into the systemic circulation. Penicillins have been dissapointing but are recommended as 1st line antibiotics.
53
Beware of extensive oesphageal candidiasis even with use of steroid inhaler.
Consider HIV
54
Pox virus in HIV/AIDs (molluscum contagiosum)
Multiple painless umbilicated papular lesions
55
CMV retinitis
Brushfure lesion with large white fluffly lesion mixed with retinal haemorrhage Ocular histoplasmosis and syphilitic choroiditis would give a fundus picture of multiple whitish lesions. Syphilitic neuroretinitis would normally give a picture of a macular star exudation.
56
Which one of the following measures would be most effective in reducing transmission of E. coli O157:H7 during an outbreak of diarrhoea caused by this organism? A. Hand washing B. Ensuring meat products fully cooked C. Isolation of individuals with diarrhoea D. Drinking only boiled water
B. Cattle are a major reservoir of Escherichia coli O157:H7 and contaminated meat is the most commonly implicated source of outbreaks.
57
EBV spot test can be negative in 25% in the 1st week of symptoms.
If atypical lymphocytes, more likely EBV anyway
58
if disseminated gonococal infection *reactive arthritis*, need to give IV ceftriaxone for minimum 48 hours, with oral cipro
Rather than single ceft + azithro
59
Gram positive filament with nodule in immunosuppression?
Nocardia | Bactrim

Infectious Diseases (4 decks)

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