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MRCP: Infectious Diseases > MRCP 2 > Flashcards

MRCP 2 Flashcards

1
Q

Gram stain of actinomyces and Norcadia ?

A

Gram-positive rods that form fungus-like branched networks of hyphae-like filaments.

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2
Q

Features of actinomyces israeli?

A

Gram-positive anaerobic bacteria from the Actinomycetaceae family.

causes oral/facial abscesses with sulphur granules in sinus tracts

May also cause abdominal mass

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3
Q

Treatment of actinomyces?

A

Long-term antibiotic therapy usually with penicillin

Surgical resection is indicated for extensive necrotic
tissue, non-healing sinus tracts, abscesses or where biopsy is needed to exclude malignancy.

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4
Q

Presentation of Norcadia?

A

typically causes pneumonia in immunocompromised patients
may also cause brain abscesses

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5
Q

Causative organism of epiglottisi?

A

Haemophilus Influenzae B

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6
Q

Thumb sign ?

A

Acute epiglottitis

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7
Q

Steeple sign?

A

Croup

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8
Q

Management of epiglottitis?

A

endotracheal intubation may be necessary to protect the airway

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9
Q

Bloody diarrhoea + Long incubation ?

A

Amoebiasis

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10
Q

Test for amoebiasis?

A

Hot stool test

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11
Q

Treatment of amoebiasis?

A

Metronidazole + diloxanide furoate

a ‘luminal agent’ (to eliminate intraluminal cysts) is recommended usually as well e.g.

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12
Q

Liver mass + content of ‘anchovy sauce’

A

Amoebiasis liver abscess

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13
Q

Investigations in amoebiasis liver abscess?

A

Ultrasound
Serology ( positive in 95%)

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14
Q

Management of amoebiasis liver abscess?

A

Metronidazole oral + luminal agent

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15
Q

Three features of antrhax toxin?

A

protective antigen
oedema factor: a bacterial adenylate cyclase which increases cAMP
lethal factor: toxic to macrophages

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16
Q

painless black eschar ( cutaneous malignant pustule) + marked oedema + GI bleeding

A

Anthrax

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17
Q

Management of anthrax?

A

Ciprofloxacin

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18
Q

Gram stain of anthrax?

A

Bacillus anthrax
Gram positive rod

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19
Q

Antibiotic: exacerbation chronic bronchitis?

A

Amoxicillin
Or
Tetracycline
Or
Clarithromycin

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20
Q

Antibiotic: Uncomplicated pneumonia?

A

Amoxicillin

(Doxcycline or clarithromycin if pen allergic)

If staph suspected cosider adding flucloxacillin

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21
Q

Antibiotic: Pneumonia caused by atypicals?

A

Clarithromycin

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22
Q

Antibiotic: HAP?

A

Within 5 days of admission: co-amoxiclav or cefuroxime

More than 5 days after admission: piperacillin with tazobactam OR a broad-spectrum cephalosporin (e.g. ceftazidime) OR a quinolone (e.g. ciprofloxacin)

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23
Q

Antibiotic: Lower urinary tracrt infection?

A

Trimethoprim or nitrofurantoin.

Alternative: amoxicillin or cephalosporin

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24
Q

Antibiotic: Acute pyelonephritis?

A

Broad-spectrum cephalosporin or quinolone

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25
Q

Antibiotic: Acute prostatitis?

A

Quinolone or trimethoprim

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26
Q

Antibiotic: Impetigo?

A

Topical hydrogen peroxide

Or oral flucloxacillin or erythromycin if widespread

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27
Q

Antibiotic: Cellulitis?

A

Flucloxacillin

(clarithromycin, erythromycin or doxycycline if penicillin-allergic)

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28
Q

Antibiotic: Cellulitis near nose and mouth ?

A

Co-amoxiclav (clarithromycin, + metronidazole if penicillin-allergic)

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29
Q

Antibiotic: Erysipelas?

A

Flucloxacillin* (clarithromycin, erythromycin or doxycycline if penicillin-allergic)

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30
Q

Antibiotic: Animal bite or human bite?

A

Co-amoxiclav (doxycycline + metronidazole if penicillin-allergic)

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31
Q

Antibiotic: Mastitis?

A

Flucloxacillin

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32
Q

Antibiotic: Throat infection?

A

Phenoxymethylpenicillin (erythromycin alone if penicillin-allergic)

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33
Q

Antibiotic: Sinusitis?

A

Phenoxymethylpenicillin

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34
Q

Antibiotic: Otitis Media?

A

Amoxicillin (erythromycin if penicillin-allergic)

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35
Q

Antibiotic: Otitis externa?

A

Flucloxacillin (erythromycin if penicillin-allergic)

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36
Q

Antibiotic: Gingivitis?

A

Metronidazole

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37
Q

Antibiotic: Gonorrohoea?

A

Intramuscular ceftriaxone

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38
Q

Antibiotic: Chlamydia?

A

Doxycycline or azithromycin

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39
Q

Antibiotic: Pelvic inflammatory disease?

A

Oral ofloxacin + oral metronidazole or intramuscular ceftriaxone + oral doxycycline + oral metronidazole

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40
Q

Antibiotic: Syphilus?

A

Benzathine benzylpenicillin or doxycycline or erythromycin

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41
Q

Antibiotic: Bacterial vaginosis?

A

Oral or topical metronidazole or topical clindamycin

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42
Q

Antibiotic: C-DIff?

A

First episode: oral vancomycin

Second or subsequent episode of infection: oral fidaxomicin

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43
Q

Antibiotic: Campylobacter?

A

Clarithromycin

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44
Q

Antibiotic: Ciprofloxacin?

A

Ciprofloxacin

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45
Q

Antibiotic: Shigellosis?

A

Ciprofloxacin

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46
Q

Antiviral: HSV or VZV ?

A

Aciclovir

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47
Q

Adverse effect of aciclovir?

A

Crystal nephropathy

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48
Q

Antiviral: CMV

A

Ganiciclovir

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49
Q

Adverse effect of ganiciclovir?

A

Myelosuppression

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50
Q

Antiviral: Chronic Hepatitis C

A

Ribiravin

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51
Q

Antiviral: RSV?

A

Ribiravin

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52
Q

Adverse effect of ribiravin?

A

Haemolytic anaemia

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53
Q

Antiviral: Influenza?

A

Amantidine
(also used in parkinsons)

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54
Q

Adverse effect of amantidine?

A

Confusion
Slurred speech

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55
Q

Antiviral: CMV?

A

Foscarnet

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56
Q

Adverse effect of foscarnet?

A

Nephrotoxicity, hypocalcaemia, hypomagnasaemia, seizures

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57
Q

Antiviral: Chronic hepatitis B & C, hairy cell leukaemia

A

Interferon alpha

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58
Q

Adverse effect of interferon alpha?

A

Flu-like symptoms, anorexia, myelosuppression

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59
Q

Antiviral: CMV retinitis in HIV?

A

Cidofovir

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60
Q

Adverse effect of cidofovir?

A

Nephrotoxicity

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61
Q

Cresecent sign?

A

Aspergilloma

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62
Q

Bacterial vaginosis criteria:

A
  1. Thin, white homogenous discharge
  2. Clue cells on microscopy: stippled vaginal epithelial cells
  3. Vaginal pH > 4.5
  4. Positive whiff test (addition of potassium hydroxide results in fishy odour)
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63
Q

Treatment of bacterail vaginosis?

A

Oral metronidazole

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64
Q

Differences between bacterial vaginosis and trichomonas?

A

White dischagre – > BV
Green / yellow / frothy –> Trichomonas
Vulvovaginitis –> Trichomonas
Strawberry cervix –> Trichomonas

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65
Q

Pregnancy + Bacteial vaginosis?

A

Oral metrondizole

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66
Q

Management of bed bugs?

A

Topical hydrocortisone

Extermination

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67
Q

Gram stain of botulism?

A

gram positive anaerobic bacillus

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68
Q

Mechanism of botulism?

A

produces botulinum toxin, a neurotoxin which irreversibly blocks the release of acetylcholine

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69
Q

Features of botulism?

A

patient usually fully conscious with no sensory disturbance

FLACCID PARALYSIS

diplopia
ataxia
bulbar palsy

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70
Q

Management of botulism?

A

botulism antitoxin and supportive care

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71
Q

Who gets brucellosis?

A

Vets
Abattoir workers

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72
Q

Incubation of brucellosis?

A

2-6 weeks

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73
Q

Features of brucellosis?

A

non-specific: fever, malaise
hepatosplenomegaly
sacroiliitis: spinal tenderness may be seen
complications: osteomyelitis, infective endocarditis, meningoencephalitis, orchitis
leukopenia often seen

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74
Q

Diagnosis of brucellosis?

A

Rose Bengal plate test can be used for screening but other tests are required to confirm the diagnosis

Best test** –> Serology

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75
Q

Treatment of brucellosis?

A

doxycycline and streptomycin

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76
Q

Causative organism of bubonic plague?

A

Yserinia pestis

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77
Q

Vector of the plague?

A

Fleas transmit the bacteria from rodents to humans via their bite

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78
Q

What are carbopenems@?

A

β-lactam antibiotics that are resistant to most β-lactamases.

Meropenem
Imipenem

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79
Q

Causative organism of cat scratch disease?

A

Bartonella

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80
Q

Features of cat scratch disease?

A

fever
history of a cat scratch
regional lymphadenopathy
headache, malaise

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81
Q

How is chicken pocks so infections ?

A

Infectious 4 days prior to rash

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82
Q

Incubation of chicken pocks?

A

21 days

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83
Q

Who should recieve varicella immunoglobulin?

A

Immunocompromised
Newborns

Others: check immunoglobulin levels

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84
Q

Who should receive varicella immunoglobulin?

A

Immunocompromised
Newborns

Others: check immunoglobulin levels

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85
Q

What is a common complication post chicken poxs?

A

Manifest as a single infected lesion/small area of cellulitis

Rare cases can have necrotising fascitis
invasive group A streptococcal soft tissue infections may occur resulting in necrotizing fasciitis

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86
Q

Features of foetal varicella syndrome?

A

skin scarring, eye defects (microphthalmia), limb hypoplasia, microcephaly and learning disabilities

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87
Q

Varicella exposure + < 20 weeks + non immunised?

A

given varicella-zoster immunoglobulin (VZIG)

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88
Q

Varicella exposure + >20 weeks + non immunised?

A

VZIG or antivirals (aciclovir or valaciclovir) should be given days 7 to 14 after exposure

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89
Q

> 20 weeks Pregnant + Develops chicken poxs?

A

oral aciclovir should be given if the pregnant women is ≥ 20 weeks and she presents within 24 hours of onset of the rash

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90
Q

< 20 weeks Pregnant + develops chickenpox?

A

Oral aciclovir

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91
Q

What causes Chikungunya?

A

Alphavirus disease caused by infected mosquitoes

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92
Q

Dengue like symptoms + severe bone pain?

A

Chikungunya

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93
Q

Features of measles?

A

Prodrome: irritable, conjunctivitis, fever
Koplik spots: white spots (‘grain of salt’) on buccal mucosa
Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent

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94
Q

Features of mumps?

A

Fever, malaise, muscular pain
Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%

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95
Q

Features of rubella?

A

Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day

Lymphadenopathy: suboccipital and postauricular

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96
Q

Causes of erythema infectiosum?

A

Parvovirus B19

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97
Q

Features of erythema infectiosum?

A

slapped-cheek syndrome’
Caused by parvovirus B19
Lethargy, fever, headache
‘Slapped-cheek’ rash spreading to proximal arms and extensor surfaces

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98
Q

Features of scarlet fever?

A

Fever, malaise, tonsillitis
‘Strawberry’ tongue
Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)

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99
Q

Causative organism of scarlet fever?

A

Group A haemolytic streptococci

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100
Q

Cause of hand foot and mouth disease?

A

coxsackie A16 virus

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101
Q

Features of hand foot and mouth disease?

A

Vesicles in the mouth and on the palms and soles of the feet

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102
Q

Complications of chlamydia?

A

epididymitis
pelvic inflammatory disease
endometritis
increased incidence of ectopic pregnancies
infertility
reactive arthritis
perihepatitis (Fitz-Hugh-Curtis syndrome)

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103
Q

Investigation for chlamydia?

A

nuclear acid amplification tests (NAATs) are now the investigation of choice

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104
Q

Male and female test for chlamydia?

A

for women: the vulvovaginal swab is first-line
for men: the urine test is first-line

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105
Q

When is the ideal time to test for chlamydia?

A

2 weeks after exposure

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106
Q

Treatment of chlamydia?

A

Doxycycline 7 days

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107
Q

Pregnant + chlamdyia?

A

azithromycin, erythromycin or amoxicillin

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108
Q

Contact tracing for men for chlamydia?

A

4 weeks

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109
Q

Contact tracing for women with chlamydia?

A

6 weeks

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110
Q

Toxin produces by clostridium perfringens?

A

Alpha toxin
Causesgas gangrene and haemolysis

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111
Q

Toxin produced by Clostrium difficle?

A

Exotoxin + Cytotoxin

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112
Q

Toxin produced by clostrium tetani?

A

exotoxin (tetanospasmin) that prevents the release of glycine

Renshaw cells in the spinal cord causing a spastic paralysis

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113
Q

Management of croup?

A

General management:
oral dexamethasone (0.15mg/kg) to all children regardless of severity

EMERGENCY MANAGEMENT:
high-flow oxygen
nebulised adrenaline

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114
Q

Most common cause of protozol diarrhoea in UK ?

A

Cryptosporidium

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115
Q

Features of cryptococcus?

A

watery diarrhoea
abdominal cramps
fever

Immunocompromised: entire gastrointestinal tract may be affected resulting in complications such as sclerosing cholangitis and pancreatitis

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116
Q

Investigation for cryptococcus?

A

Modified ziehl neilson staining

Demonstrates red cysts

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117
Q

Management of cryptococcus?

A

Largley supportive

nitazoxanide may be used for immunocompromised patients

rifaximin is also sometimes used for immunocompromised patients/patients with severe disease

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118
Q

What is the causative organism of cutaneous larva migrans?

A

Ancyclostoma braziliense.

Hook worm

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119
Q

Management of cutaneous larva migrans?

A

albendazole
or
ivermectin.

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120
Q

Congential CMV infection?

A

pinpoint petechial ‘blueberry muffin’ skin lesions, microcephaly, sensorineural deafness, encephalitiis (seizures) and hepatosplenomegaly

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121
Q

Glandular fever features + no atyical lymphocytes + negative EBV

A

CMV mononucleosis
Can occur in immunocompetent people

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122
Q

Features of CMV retinitis?

A

common in HIV patients with a low CD4 count (< 50)

presents with visual impairment e.g. ‘blurred vision’.

Fundoscopy shows retinal haemorrhages and necrosis, often called ‘pizza’ retina

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123
Q

Management of CMV retinitis?

A

IV ganciclovir is the treatment of choice

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124
Q

What are the viral haemorrhagic fevers?

A

yellow fever
Lassa fever
Ebola
Dengue fever

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125
Q

How is dengue fever transmitted?

A

Aedes aegypti mosquito

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126
Q

Features of dengue fever?

A

fever
headache (often retro-orbital)
myalgia, bone pain and arthralgia (‘break-bone fever’)
pleuritic pain
facial flushing (dengue)
maculopapular rash
haemorrhagic manifestations e.g. positive tourniquet test, petechiae, purpura/ecchymosis, epistaxis

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127
Q

What are dengue warning signs? - Meaning it should be classed as severe?

A

abdominal pain
hepatomegaly
persistent vomiting
clinical fluid accumulation (ascites, pleural effusion)

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128
Q

What is features of severe dengue haemorrhagic fever?

A

disseminated intravascular coagulation (DIC) resulting in:
thrombocytopenia
spontaneous bleeding
Dengue shock syndrome

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129
Q

Diagnostic tests for dengue fever?

A

serology
nucleic acid amplification tests for viral RNA
NS1 antigen test

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130
Q

What is the causative organism of diptheria?

A

Corynebacterium diphtheriae

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131
Q

Features of diptheria?

A

‘diphtheric membrane’ on tonsils caused by necrotic mucosal cells

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132
Q

Fetures of diptheria?

A

Recent visitors to Eastern Europe/Russia/Asia

Sore throat with a ‘diphtheric membrane’ - grey

Pseudomembrane on the posterior pharyngeal wall
bulky cervical lymphadenopathy

May result in a ‘bull neck’ appearanace

neuritis e.g. cranial nerves

Heart block

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133
Q

Investigations for diptheria?

A

Tellurite agar
Loeffler’s media

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134
Q

Management of diphtheria?

A

intramuscular penicillin
diphtheria antitoxin

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135
Q

What is the only non-double stranded DNA virus?

A

Parvovirus

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136
Q

Cause of molloscum contagiosum?

A

Pox virus

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137
Q

Example of polyoma virus?

A

JC virus

Causes progressive multifocal leukoencephalopathy)

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138
Q

What are the DNA viruses?

A

HHAPPPPy!
Hepadna
Herpes
Adeno
Pox
Parvo
Papilloma
Polyoma

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139
Q

What causes typhoid and paratyphod respectively?

A

Salmonella typhi
Salmonella paratyphi

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140
Q

Features of enteric fever?

A

Initially systemic upset
Relative bradycardia
Abdominal pain, distension
Constipation: although Salmonella is a recognised cause of diarrhoea, constipation is more common in typhoid
Rose spots: present on the trunk in 40% of patients, and are more common in paratyphoid

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141
Q

How to differentiate between typhoid and paratyphoid?

A

Rose spots –> more common in paratyphoid
Constipation more common in typhoid

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142
Q

Definition of travellers diarrhoea?

A

3 loose to watery stools in 24 hours

with / without:
one of more of abdominal cramps, fever, nausea, vomiting or blood in the stool

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143
Q

Gastroenteritis:
Common amongst travellers
Watery stools
Abdominal cramps and nausea

A

E coli

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144
Q

Prolonged, non-bloody diarrhoea

A

Giardiasis

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145
Q

Profuse, watery diarrhoea
Severe dehydration resulting in weight loss
Not common amongst travellers

A

Cholera

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146
Q

Bloody diarrhoea
Vomiting and abdominal pain

A

Shigella

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147
Q

Severe vomiting
Short incubation period

A

Staph aureus

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148
Q

A flu-like prodrome is usually followed by crampy abdominal pains, fever and diarrhoea which may be bloody
May mimic appendicitis
Complications include Guillain-Barre syndrome

A

Campylobacter

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149
Q

Gradual onset bloody diarrhoea, abdominal pain and tenderness which may last for several weeks

A

Amoebiasis

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150
Q

Gastroenteritis incubation: 1-6 hours

A

Staphylococcus aureus
Bacillus cereus*

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151
Q

Gastroenteritis incubation: 12-48 hours

A

Salmonella
Escherichia coli

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152
Q

Gastroenteritis incubation: 48-72 hours:

A

Shigella, Campylobacter

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153
Q

Gastroenteritis incubaton > 7 days

A

Giardiasis, Amoebiasis

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154
Q

What type of organism is giardiasis?

A

Flagellate protozoan Giardia lamblia

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155
Q

Features of giardiasis?

A

often asymptomatic

NON BLODDY

steatorrhoea
bloating, abdominal pain
lethargy
flatulence
weight loss
malabsorption and lactose intolerance can occur

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156
Q

Best test for giardiasis?

A

stool microscopy for trophozoite and cysts: sensitivity of around 65%

Best teststool antigen detection assay: greater sensitivity and faster turn-around time than conventional stool microscopy methods

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157
Q

Treatment of giardiasis?

A

Metronidazole

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158
Q

Features of gonorrhea in men?

A

males: urethral discharge, dysuria

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159
Q

Features of gonorrhea in women?

A

females: cervicitis e.g. leading to vaginal discharge

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160
Q

What is the treatment of gonorrhea?

A

IM ceftriaxone

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161
Q

Patient needle phobic: Treatment of gonorrhea?

A

oral cefixime 400mg (single dose) + oral azithromycin 2g (single dose)

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162
Q

Complications of gonorrohea infection?

A

Disseminated gonorrhea infection
Gonnoccocal infection

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

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163
Q

Features of disseminated gonorrhea infection?

A

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

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164
Q

Is hand foot and mouth related to cattle

A

No nothing to do with it

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165
Q

How do you acquire a strongyloides infection?

A

Larvae are present in soil and gain access to the body by penetrating the skin

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166
Q

Features of strongyloides infection?

A

Diarrhoea, abdominal pain, papulovesicular lesions

larva currens: pruritic, linear, urticarial rash, if the larvae migrate to the lungs a pneumonitis similar to Loeffler’s syndrome

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167
Q

Treatment of strongyloides?

A

Bendazoles
Or Invermetacin

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168
Q

Features of Enterobius vermicularis infection?

A

Thread worm
include perianal itching, particularly at night; girls may have vulval symptoms

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169
Q

How do you diagnose enterobius vermicularis?

A

Diagnosis may be made by the applying sticky plastic tape to the perianal area and sending it to the laboratory for microscopy to see the eggs

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170
Q

What is hook worm called?

A

Ancylostoma duodenale
Necator americanus

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171
Q

Features of hook worm infection?

A

Larvae penetrate skin of feet; gastrointestinal infection → anaemia
Thin-shelled ova

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172
Q

Treatment of hook worm?

A

Bendazoles

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173
Q

Features of loa loa?

A

Causes red itchy swellings below the skin called ‘Calabar swellings’, may be observed when crossing conjunctivae

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174
Q

What is the transmission of loa loa?

A

Mango fly

Deer fly

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175
Q

Treatment of loa loa ?

A

Diethylcarbamazine

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176
Q

Nematode infection caught from eating pork?

A

Trichinella spiralis

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177
Q

Features of Trichinella spiralis infection?

A

Features include fever, periorbital oedema and myositis (larvae encyst in muscle)

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178
Q

Treatment of Trichnella spiralis?

A

Bendazoles

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179
Q

Nematode that causes blindness?

A

Onchocerca volvulus
Causes river blindness

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180
Q

How is onchocerca volvulus spread?

A

Female blackflies

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181
Q

Features of onchocerca volvulus?

A

Features include fever, periorbital oedema and myositis (larvae encyst in muscle)

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182
Q

Treatment of onchocerca volvulus?

A

Ivermetacin

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183
Q

Nematode that causes elphantiasis?

A

Wuchereria bancrofti

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184
Q

How is Wuchereria bancrofti spread?

A

Female mosquito

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185
Q

Treatment of Wuchereria bancrofti

A

Diethylcarbamazine

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186
Q

visceral larva migrans and retinal granulomas

A

Toxocara canis (dog roundworm)

VISCious dogs → blindness

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187
Q

Tape worm acquired from dog faecus and eggs

A

Echinococcus granulosus

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188
Q

Tapeworm acquired from undercooked pork?

A

Taenia solium

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189
Q

Causes ‘swimmer’s itch’ - frequency, haematuria. Risk factor for squamous cell bladder cancer

A

Schistosoma haematobium

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190
Q

Treatment of schistosoma?

A

Praziquantel

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191
Q

How is hepatitis B acquired?

A

exposure to infected blood or body fluids,

including vertical transmission from mother to child.

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192
Q

Features of hepatitis B infection?

A

fever, jaundice and elevated liver transaminases.

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193
Q

Complications of hepatitis B infection?

A

chronic hepatitis (5-10%). ‘Ground-glass’ hepatocytes may be seen on light microscopy
fulminant liver failure (1%)
hepatocellular carcinoma
glomerulonephritis
polyarteritis nodosa
cryoglobulinaemia

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194
Q

How do you check response of hepatitis vaccine?

A

Anti-HBs

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195
Q

What does an anti-HBs level of >100 indicate?

A

Indicates adequate response, no further testing required. Should still receive booster at 5 years

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196
Q

What does an anti-HBs level of 10-100 indicate?

A

Suboptimal response - one additional vaccine dose should be given.

If immunocompetent no further testing is required

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197
Q

What does an anti-HBs level of < 10 indicate?

A

Non-responder. Test for current or past infection. Give further vaccine course (i.e. 3 doses again) with testing following. If still fails to respond then HBIG would be required for protection if exposed to the virus

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198
Q

Two time complete course of heptatitis vaccine + still not responding. What is the management?

A

HBIG if exposured

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199
Q

What is the treatment of hepatitis B ?

A

tenofovir, entecavir and telbivudine (a synthetic thymidine nucleoside analogue)

Old medication: pegylated interferon-alpha

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200
Q

Who gets hepatitis C?

A

Intravenous drug uses

201
Q

Complications of hepatitis C?

A

rheumatological problems: arthralgia, arthritis
eye problems: Sjogren’s syndrome
cirrhosis (5-20% of those with chronic disease)
hepatocellular cancer
cryoglobulinaemia: typically type II (mixed monoclonal and polyclonal)
porphyria cutanea tarda (PCT)
membranoproliferative glomerulonephritis

202
Q

Is breast feeding contraindicated in hepatitis C?

203
Q

Can you breast feed with hepatitis B

204
Q

What type of virus is hepatitis C?

A

hepatitis C is a RNA flavivirus

205
Q

How is hepatitis C defined?

A

persistence of HCV RNA in the blood for 6 months.

206
Q

What is the treatment for hepatitis C?

A

depends on the viral genotype - this should be tested prior to treatment

daclatasvir + sofosbuvir or sofosbuvir + simeprevir) with or without ribavirin are used

Interferon no longer used

207
Q

Side effect of ribavirin?

A

Haemolytic anaemia, cough. Women should not become pregnant within 6 months of stopping ribavirin as it is teratogenic

208
Q

Side effect of interferon?

A

flu-like symptoms, depression, fatigue, leukopenia, thrombocytopenia

209
Q

What does Hepatitis D require?

A

Requires hepatitis B surface antigen to complete replication cycle

210
Q

What is a hepatitis D co-infection?

A

Hepatitis B and Hepatitis D infection at the same time.

211
Q

What is a heptatitis D super added infection?

A

A hepatitis B surface antigen positive patient subsequently develops a hepatitis D infection.

212
Q

What has a worse prognosis: Co-infection of hepatitis D or superadded infection?

A

Superadded infection

213
Q

Treatment for hepatitis D?

A

Interferon alpha

214
Q

Women with new LFT rise and its hepatitis?

A

Hepatitis E

215
Q

HSV: Oral lesion?

216
Q

HSV: Genital lesions ?

217
Q

What is the cut off for viral load in HIV +ve lady who is pregnant: C section vs vaginal?

A

vaginal delivery is recommended if viral load is less than 50 copies/ml at 36 weeks, otherwise caesarian section is recommended

218
Q

What should be commenced before c section in HIV +ve woman?

A

zidovudine infusion should be started four hours before beginning the caesarean section

219
Q

Neonate: Mothers HIV viral load < 50?

A

zidovudine is usually administered orally to the neonate if maternal viral load is <50 copies/ml.

220
Q

Neonate: Mothers HIV viral load > 50?

A

ART should be used. Therapy should be continued for 4-6 weeks.

221
Q

Breast feeding in HIV +ve?

222
Q

HIV related CMV retinitis:
Cell count?

223
Q

Appearance of CMV retinitis?

A

characteristic appearance showing retinal haemorrhages and necrosis
often called ‘pizza’ retina

224
Q

Management of CMV retiniits?

A

IV ganciclovir

treatment used to be life-long but new evidence suggests that it may be discontinued once CD4 > 150 after HAART

alternative: IV foscarnet or cidofovir

225
Q

Most common cause of HIV diarrhoea?

A

Cryptosporidium

226
Q

Causes of HIV diarrhoea?

A

Cryptosporidium + other protozoa (most common)
Cytomegalovirus
Mycobacterium avium intracellulare
Giardia

227
Q

Cause of kaposi sarcoma?

A

HHV-8 (human herpes virus 8)

228
Q

What is the treatment regimen for HIV?

A

combination of at least three drugs, typically two nucleoside reverse transcriptase inhibitors (NRTI) and either a protease inhibitor (PI) or a non-nucleoside reverse transcriptase inhibitor (NNRTI).

229
Q

What is an example of a entry inhibitor in HIV?

A

maraviroc (binds to CCR5, preventing an interaction with gp41), enfuvirtide (binds to gp41, also known as a ‘fusion inhibitor’)

230
Q

What virus can maraviroc be used for?

231
Q

When should you be concerned for Mycobacterium avium complex?

A

CD4 count is less than 50 cells/mm³

232
Q

Features of mycobacterium avid complex?

A

fever, sweats
abdominal: pain, diarrhoea
lung: dyspnoea, cough
anaemia
lymphadenopathy
hepatomegaly/deranged LFTs

233
Q

How do you prevent mycobacterium avian complex?

A

clarithromycin or azithromycin when CD4 is less than 100 cells/mm³

234
Q

Management of mycobacterium avid complex?

A

rifampicin + ethambutol + clarithromycin

235
Q

Most common neurological complication of HIV?

A

Toxoplasmosis

236
Q

Features of toxoplasmosis in HIV?

A

constitutional symptoms, headache, confusion, drowsiness

237
Q

Scan findings for toxoplasmosis in CT?

A

CT: usually single or multiple ring enhancing lesions, mass effect may be seen

238
Q

Treatment of toxoplasmosis?

A

management: sulfadiazine and pyrimethamine

239
Q

How to differentiate between toxoplasmosis and lymphoma?

A

Toxoplasmosis:
Multiple lesions
Ring or nodular enhancement
Thallium SPECT negative

Lymphoma:
Single lesion
Solid (homogenous) enhancement
Thallium SPECT positive

240
Q

HIV: Primary CNS lymphoma is related to what virus?

241
Q

CSF:
high opening pressure
elevated protein
reduced glucose
normally a lymphocyte predominance but in HIV white cell count many be normal
India ink test positive

A

Cryptococcus

242
Q

Viruses that causes Progressive multifocal leukoencephalopathy (PML)?

243
Q

Features of AIDs dementia complex?

A

caused by HIV virus itself
symptoms: behavioural changes, motor impairment
CT: cortical and subcortical atrophy

244
Q

When should you worry about oesophageal candidiasis?

245
Q

Treatment for oesophageal candidiasis?

A

Fluconazole and itraconazole are first-line treatments.

246
Q

What type of organism is PCP?

A

Pneumocystis carinii pneumonia (PCP)

247
Q

Features of PCP?

A

dyspnoea
dry cough
fever
very few chest signs

Pneumothorax

248
Q

Exercised induced desaturation

249
Q

What test should be done to test for PCP?

A

bronchoalveolar lavage (BAL) often needed to demonstrate PCP (silver stain shows characteristic cysts)

250
Q

Management of PCP

A

co-trimoxazole
IV pentamidine in severe cases

251
Q

When does seroconversion occur in HIV?

A

3-12 weeks after infection

252
Q

How do you diagnose HIV?

A

antibodies to HIV may not be present
HIV PCR and p24 antigen tests can confirm diagnosis

253
Q

Which HIV is known to be worse?

A

HIV1 is worse than HIV 2

254
Q

What is a Immune reconstitution inflammatory syndrome?

A

condition generally associated with HIV/immunosuppression
immune system begins to recover,
overwhelming inflammatory response that paradoxically makes the symptoms of infection worse.

255
Q

What virus causes infectious mononucleosis?

A

Epstein-Barr virus (EBV, also known as human herpesvirus 4, HHV-4)

256
Q

What is the triad of infectious mononucleosis?

A

sore throat

lymphadenopathy: may be present in the anterior and posterior triangles of the neck, in contrast to tonsillitis which typically only results in the upper anterior cervical chain being enlarged

pyrexia

257
Q

Features of infectious mononucleosis?

A

palatal petechiae

splenomegaly - occurs in around 50% of patients and may rarely predispose to splenic rupture

hepatitis, transient rise in ALT

lymphocytosis: presence of 50% lymphocytes with at least 10% atypical lymphocytes

haemolytic anaemia secondary to cold agglutins (IgM)
a maculopapular, pruritic rash develops in around 99% of patients who take ampicillin/amoxicillin whilst they have infectious mononucleosis

258
Q

How to diagnose infectious mononucleosis?

A

heterophil antibody test (Monospot test)

259
Q

Criteria to start antivirals in influenza?

A

Symptoms within 48 hours

> 65 years old
pregnant women
chronic disease of respiratory, cardiac, renal, hepatic or neurological nature
diabetes
immunosuppression
morbid obesity.

260
Q

Management of influenza?

A

First line: oseltamivir

Second line: zanamivir

261
Q

How is a Japanese encephalitis virus spread?

A

culex mosquitos which breeds in rice paddy fields

262
Q

Presentation of JC encephalitis?

A

headache, fever, seizures and confusion.
Parkinsonian features indicate basal ganglia involvement.
It can also present with acute flaccid paralysis.

263
Q

Differences between legionella and mycoplasma?

A

Lymphopaenia –> Legionella
Hyponatraemia –> legionella
Haemolytic anaemia –> Mycoplasma
Erythema multiform –> Mycoplasma
encephalitis –> mycoplasma
Myocardiis –> mycoplasma

264
Q

Diagnosis of legionella?

A

Urinary antigen

265
Q

Diagnosis of mycoplasma?

266
Q

Treatment for legionella?

A

treat with erythromycin/clarithromycin

267
Q

What causes leishmiasis?

A

Leishmania tropica
Leishmania mexicana

268
Q

How is leishmiassi typically diagnosed?

A

punch biopsy

269
Q

Acquiring leishmaniasis from where means it needs treatment?

A

cutaneous leishmaniasis acquired in South or Central America merits treatment due to the risk of mucocutaneous leishmaniasis

acquired in Africa or India can be managed more conservatively

270
Q

Causes of mucocutaneous leishmaniasis ?

A

Leishmania braziliensis

271
Q

Features of mucocutaneous leishmaniasis ?

A

involve mucosae of nose, pharynx etc

272
Q

What is kala-azar ?

A

Visceral leishmaniasis

273
Q

Features of visceral leishmaniasis ?

A

Greyish skin –> Kala Azar
fever, sweats, rigors
massive splenomegaly. hepatomegaly
poor appetite*, weight loss
pancytopaenia secondary to hypersplenism

274
Q

What is the gold standard for diagnosis of visceral leishmaniasis ?

A

bone marrow or splenic aspirate

275
Q

Causative of leprosy?

A

Mycobacterium leprae.

276
Q

Features of leprosy?

A

hypopigmented skin typically affecting the buttocks, face, and extensor surfaces of limbs
sensory loss

277
Q

Lepromatous leprosy?

A

Low degree of cell mediated immunity
extensive skin involvement
symmetrical nerve involvement

278
Q

Tuberculoid leprosy (‘paucibacillary’) ?

A

limited skin disease
asymmetric nerve involvement → hypesthesia
hair loss

279
Q

Treatment of leprosy?

A

rifampicin, dapsone and clofazimine

280
Q

Features of leptospirosis?

A

Early phase is due to bacteraemia and lasts around a week:
may be mild or subclinical
fever
flu-like symptoms
subconjunctival suffusion (redness)/haemorrhage

may lead to more severe disease (Weil’s disease)
acute kidney injury (seen in 50% of patients)
hepatitis: jaundice, hepatomegaly
aseptic meningitis

281
Q

What is Weil’s disease?

A

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

282
Q

How to diagnose leptospirosis?

A

serology: antibodies to Leptospira develop after about 7 days

283
Q

Management of leptospirosis ?

A

high-dose benzylpenicillin or doxycycline

284
Q

What type of bacteria is leptospirosis?

A

Gram-positive bacillus

285
Q

CSF findings of listeriosis?

A

cerebrospinal fluid findings:
pleocytosis, often lymphocytes (nontuberculous bacteria usually cause a rise in neutrophils)
raised protein
reduced glucose

286
Q

Management of listeria?

A

Listeria is sensitive to amoxicillin/ampicillin (cephalosporins usually inadequate)

Meningitis: Listeria meningitis should be treated with IV amoxicillin/ampicillin and gentamicin

287
Q

Who is more likely to get listeria?

A

Pregnant women

288
Q

Features of listeriosis?

A

gastroenteritis
diarrhoea
bacteraemia
flu-like illness
central nervous system infection
meningoencephalitis
ataxia
seizures

289
Q

What is loiasis?

A

a filarial infection caused by Loa Loa.

290
Q

Features of loiasis ?

A

pruritus
urticaria
Calabar swellings: transient, non-erythematous, hot swelling of soft-tissue around joints
‘eye worm’ - the dramatic presentation of subconjunctival migration of the adult worm.

291
Q

What causes Lyme disease ?

A

Borrelia burgdorferi and is spread by ticks.

292
Q

Early features of Lyme disease?
< 30 days

A

erythema migrans
‘bulls-eye’ rash is typically at the site of the tick bite
typically develops 1-4 weeks after the initial bite but may present sooner
usually painless, more than 5 cm in diameter and slowlly increases in size
present in around 80% of patients.

293
Q

What is the later features of Lyme disease?
> 30 days

A

cardiovascular
- heart block
- peri/myocarditis
neurological
- facial nerve palsy
- radicular pain
- meningitis

294
Q

When can Lyme disease be diagnosed clinically?

A

If erythema migrans is present

295
Q

Diagnosis of Lyme disease ?

A

(ELISA) antibodies to Borrelia burgdorferi are the first-line test

296
Q

When should ELISA for Lyme disease be repeat?

A

if negative and Lyme disease is still suspected in people tested within 4 weeks from symptom onset, repeat the ELISA 4-6 weeks after the first ELISA test

297
Q

Management of asymptomatic tick bite?

A

NICE guidance does not recommend routine antibiotic treatment to patients who’ve suffered a tick bite

298
Q

Management of Lyme disease?

A

doxycycline if early disease.

Amoxicillin is an alternative if doxycycline is contraindicated (e.g. pregnancy)

299
Q

Management of disseminated Lyme disease?

A

ceftriaxone if disseminated disease

300
Q

What is a Jarisch-Herxheimer reaction?

A

fever, rash, tachycardia after first dose of antibiotic (more commonly seen in syphilis, another spirochaetal disease)

301
Q

Features of severe malaria falciparum ?

A

schizonts on a blood film
parasitaemia > 2%
hypoglycaemia
acidosis
temperature > 39 °C
severe anaemia
complications as below

302
Q

What is blackwater fever?

A

Malaria acute renal failure: blackwater fever, secondary to intravascular haemolysis, mechanism unknown

303
Q

First line treatment in non severe malaria falciparum ?

A

artemisinin-based combination therapies (ACTs) as first-line therapy

artemether plus lumefantrine, artesunate plus amodiaquine, artesunate plus mefloquine, artesunate plus sulfadoxine-pyrimethamine, dihydroartemisinin plus piperaquine

304
Q

Management of severe malaria falciparum ?

A

intravenous artesunate

305
Q

When should exchange transfusion be completed for malaria?

A

Parasite count > 10%

306
Q

Common non-malaria falciparums?

A

Plasmodium vivax
Plasmodium ovale
Plasmodium malariae

307
Q

Presentation of plasmodium oval and vivax?

A

Plasmodium oval: cyclical fever every 48 hours.
Plasmodium malariae: cyclical fever every 72 hours

308
Q

Presentation plasmodium malariae?

A

Nephrotic syndrome

309
Q

Treatment of malaria non-falciparum?

A

artemisinin-based combination therapy (ACT) or chloroquine

310
Q

Management of plasmodium vivax and oval?

A

Acute treatment: ACT

REQUIREMENT MAINTENANCE TREATMENT
primaquine following acute treatment with chloroquine

311
Q

Complications from measles?

A

otitis media: the most common complication
pneumonia: the most common cause of death
encephalitis: typically occurs 1-2 weeks following the onset of the illness)
subacute sclerosing panencephalitis: very rare, may present 5-10 years following the illness
febrile convulsions
keratoconjunctivitis, corneal ulceration
diarrhoea
increased incidence of appendicitis
myocarditis

312
Q

Most common cause of meningitis in 0-3?

A

Group B Streptococcus (most common cause in neonates)
E. coli
Listeria monocytogenes

313
Q

Most common cause of meningitis in 3 months to 6 months?

A

Neisseria meningitidis
Streptococcus pneumoniae
Haemophilus influenzae

314
Q

Most common cause of meningitis in 6 years to 60 years?

A

Neisseria meningitidis
Streptococcus pneumoniae

315
Q

Most common cause of meningitis in >60 years?

A

Streptococcus pneumoniae
Neisseria meningitidis
Listeria monocytogenes

316
Q

Features of bacterial CSF?

A

Cloudy
Glucose < half of serum
Protein high
Polymorphs 10-1000

317
Q

Features of viral CSF?

A

Cloudy
60-80% of plasma glucose*
Protein Normal/raised
15 - 1,000 lymphocytes/mm³

318
Q

Features of TB CSF?

A

Slight cloudy, fibrin web
Low (< 1/2 plasma)
High protein
30 - 300 lymphocytes/mm³

319
Q

Features of fungal CSF?

A

Low glucose
High protein
20 - 200 lymphocytes/mm³

320
Q

What is the most sensitive test to diagnose TB in CSF?

A

PCR
Ziehl Neilson is only 20 % sensitive

321
Q

Warning signs in suspected meningitis?

A

rapidly progressive rash
poor peripheral perfusion
respiratory rate < 8 or > 30 / min or pulse rate < 40 or > 140 / min
pH < 7.3 or WBC< 4 *109/L or lactate > 4 mmol/L
GCS < 12 or a drop of 2 points
poor response to fluid resuscitation

322
Q

When should lumbar puncture not be done?

A

signs of severe sepsis or a rapidly evolving rash
severe respiratory/cardiac compromise
significant bleeding risk

signs of raised intracranial pressure
focal neurological signs
papilloedema
continuous or uncontrolled seizures
GCS ≤ 12

323
Q

Suspected meningitis: antibiotics 3 months - 50 years?

A

cefotaxime (or ceftriaxone)

324
Q

Suspected meningitis: antibiotics > 50 years

A

cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin) for adults

325
Q

Suspected meningitis: Initial empirical therapy aged < 3 months

A

Intravenous cefotaxime + amoxicillin (or ampicillin)

326
Q

Treatment of haemophilia influenza meningitis?

A

Intravenous cefotaxime (or ceftriaxone)

327
Q

Suspected meningitis: Listeria meningitis?

A

Intravenous amoxicillin (or ampicillin) + gentamicin

328
Q

Who should be offered prophylaxis in bacterial meningitis?

A

exposed to a patient with confirmed bacterial meningitis should be given prophylactic antibiotics if they have close contact within the 7 days before onset

329
Q

Treatment of MRSA?

A

vancomycin
teicoplanin
linezolid

330
Q

What is muchrmycosis?

A

Mucormycosis is a fungal infection that is more commonly seen in poorly controlled diabetes.

It typically infects the sinuses, lungs and brain.

331
Q

Complications of mumps?

A

orchitis - uncommon in pre-pubertal males but occurs in around 25-35% of post-pubertal males. Typically occurs four or five days after the start of parotitis
hearing loss - usually unilateral and transient
meningoencephalitis
pancreatitis

332
Q

Fish tank granuloma?

A

Mycobacterium marinum

333
Q

Causative organism of type 1 necrotising fascitis?

A

type 1 is caused by mixed anaerobes and aerobes (often occurs post-surgery in diabetics). This is the most common type

334
Q

Causative organism of type 2 necrotising fascitis?

A

Streptococcus pyogenes

335
Q

What causes orf?

A

parapox virus.
found in sheep and goat

336
Q

Presentations of parvovirus B 19

A

Erythema infectious
asymptomatic
pancytopaenia in immunosuppressed patients
aplastic crises e.g. in sickle-cell disease
chronic haemolytic anaemia
hydrops fetalis

337
Q

Causes of community acquired pneumonia?

A

Streptococcus pneumoniae (accounts for around 80% of cases)
Haemophilus influenzae
Staphylococcus aureus: commonly after influenza infection
atypical pneumonias (e.g. Due to Mycoplasma pneumoniae)
viruses

338
Q

Who gets Q fever?

A

abattoir, cattle/sheep or it may be inhaled from infected dust

339
Q

Causes of Q fever?

A

Coxiella burnetii, a rickettsia

340
Q

Features of Q fever?

A

typically prodrome: fever, malaise
causes pyrexia of unknown origin
transaminitis
atypical pneumonia
endocarditis (culture-negative)

341
Q

Treated of Q fever?

A

Doxycycline

342
Q

Negri bodies: cytoplasmic inclusion bodies found in infected neurons

343
Q

Features of Rabies?

A

prodrome: headache, fever, agitation
hydrophobia: water-provoking muscle spasms
hypersalivation
Negri bodies: cytoplasmic inclusion bodies found in infected neurons

344
Q

Rabies wound: Management?

A

human rabies immunoglobulin (HRIG) should be given along with a full course of vaccination

345
Q

Common cold virus?

A

Rhinovirus

346
Q

Most common exacerbation of bronchiectasis?

A

Haemophilus influenza

347
Q

What type of organism is rickettsiae ?

A

Gram-negative obligate intracellular parasites

348
Q

What test could be done to investigate rickettsiae?

A

Weil-Felix reaction

349
Q

Cause of endemic typhus?

A

Rickettsia typhi

Rickettsia prowazekii

350
Q

Scarlet fever incubation?

351
Q

Features of scarlet fever?

A

fever: typically lasts 24 to 48 hours
malaise, headache, nausea/vomiting
sore throat
‘strawberry’ tongue
rash

352
Q

Complications of scarlet fever?

A

otitis media: the most common complication
rheumatic fever: typically occurs 20 days after infection
acute glomerulonephritis: typically occurs 10 days after infection
invasive complications (e.g. bacteraemia, meningitis, necrotizing fasciitis) are rare but may present acutely with life-threatening illness

353
Q

How to assess the severe sepsis?

A

qSOFA score
Respiratory rate > 22/min
Altered mentation
Systolic blood pressure < 100 mm Hg

354
Q

What is a spinal epidural abscess?

A

An abscess is a collection of pus encapsulated by a pyogenic membrane.

355
Q

What is the most typical cause of Spinal epidural abscess?

A

staph aureus

356
Q

Vaccinations in splenectomy?

A

if elective, should be done 2 weeks prior to operation
Hib, meningitis A & C
annual influenza vaccination
pneumococcal vaccine every 5 years

357
Q

Antibiotic prophylaxis in splenectomy/

A

penicillin V:

358
Q

What is the antigen behind toxic shock syndrome?

A

TSST-1 superantigen toxin

359
Q

Features of Toxic shock syndrome?

A

fever: temperature > 38.9ºC
hypotension: systolic blood pressure < 90 mmHg
diffuse erythematous rash
desquamation of rash, especially of the palms and soles
involvement of three or more organ systems: e.g. gastrointestinal (diarrhoea and vomiting), mucous membrane erythema, renal failure, hepatitis, thrombocytopenia, CNS involvement (e.g. confusion)

360
Q

Coagulase positive staph?

A

Staph aureus

361
Q

What does staph aureus cause?

A

Causes skin infections (e.g. cellulitis)
abscesses
osteomyelitis
toxic shock syndrome

362
Q

Multiple painful ulcers on genitals ?

A

Gential herpes HSV2

363
Q

What type of ulcer do you get in syphilus?

A

Painless
Chancroid

364
Q

Painful genital ulcers + unilateral, painful inguinal lymph + node enlargement + sharply defined, ragged, undermined border.

A

Haemophilus ducreyi.

365
Q

Difference between Lymphogranuloma venereum (LGV) and Haemophilus ducreyi?

A

sharply defined, ragged, undermined border.

366
Q

Stages of Lymphogranuloma venereum (LGV)?

A

stage 1: small painless pustule which later forms an ulcer
stage 2: painful inguinal lymphadenopathy
stage 3: proctocolitis

367
Q

Stages of Lymphogranuloma venereum (LGV)?

A

Wstage 1: small painless pustule which later forms an ulcer
stage 2: painful inguinal lymphadenopathy
stage 3: proctocolitis

368
Q

What are the alpha haemolytic streps?

A

Streptococcus pneumoniae (pneumococcus)

Streptococcus viridans

369
Q

What are the beta haemolytic streps?

A

Group A
most important organism is Streptococcus pyogenes

Group B
Streptococcus agalactiae

Group D
Enterococcus

370
Q

Treatment of Strongyloides stercoralis?

A

ivermectin and albendazole

371
Q

Side effects of co-trimoxazole?

A

hyperkalaemia
headache
rash (including Steven-Johnson Syndrome)

372
Q

Duration from primary to secondary

A

Primary syphilus up to 6 weeks

Secondary syphilus up to 6- 10 weeks

373
Q

Features of primary and secondary syohilus?

A

Primary features
chancre - painless ulcer at the site of sexual contact
local non-tender lymphadenopathy
often not seen in women (the lesion may be on the cervix)

Secondary features - occurs 6-10 weeks after primary infection
systemic symptoms: fevers, lymphadenopathy
rash on trunk, palms and soles
buccal ‘snail track’ ulcers (30%)
condylomata lata (painless, warty lesions on the genitalia )

374
Q

Features of tertiary syphilus?

A

gummas (granulomatous lesions of the skin and bones)
ascending aortic aneurysms
general paralysis of the insane
tabes dorsalis
Argyll-Robertson pupil

375
Q

What are the types of syphilus tests?

A

non-treponemal tests
treponemal-specific tests

376
Q

Positive non-treponemal test + positive treponemal test

A

consistent with active syphilis infection

377
Q

Positive non-treponemal test + negative treponemal test

A

consistent with a false-positive syphilis result

378
Q

Negative non-treponemal test + positive treponemal test :

A

consistent with successfully treated syphilis

379
Q

What is the management of syphilus?

A

intramuscular benzathine penicillin is the first-line management
alternatives: doxycycline

380
Q

Jarisch-Herxheimer reaction treatment?

A

no treatment is needed

381
Q

Tetanus: full course of tetanus vaccines, with the last dose < 10 years ago

A

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

382
Q

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

A

High risk wound: reinforcing dose of vaccine + tetanus immunoglobulin
if tetanus prone wound: reinforcing dose of vaccine

383
Q

Tetanus:
reinforcing dose of vaccine, regardless of the wound severity

A

reinforcing dose of vaccine, regardless of the wound severity

for tetanus prone and high-risk wounds: reinforcing dose of vaccine + tetanus immunoglobulin

384
Q

Treatment for latent TB (assymtopmatic)

A

3 months of isoniazid (with pyridoxine) and rifampicin, or

6 months of isoniazid (with pyridoxine)

385
Q

Treatment of active tuberculosis (symptomatic)

A

Initial phase - first 2 months (RIPE)
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol (the 2006 NICE guidelines now recommend giving a ‘fourth drug’ such as ethambutol routinely - previously this was only added if drug-resistant tuberculosis was suspected)

Continuation phase - next 4 months
Rifampicin
Isoniazid

386
Q

Side effect of rifampicin?

A

hepatitis, orange secretions
flu-like symptoms

387
Q

Side effect of isoniazid?

A

peripheral neuropathy: prevent with pyridoxine (Vitamin B6)
hepatitis, agranulocytosis
liver enzyme inhibitor

388
Q

Side effect of pyrazinamide?

A

hyperuricaemia causing gout
arthralgia, myalgia
hepatitis

389
Q

Side effect of ethambutol?

A

optic neuritis: check visual acuity before and during treatment

390
Q

Diagnosis of active TB?

A

3 x sputum smear - stain with ziehl Neilson

Gold standard: Sputum culture

391
Q

Mantoux test: < 6mm

A

Negative - no significant hypersensitivity to tuberculin protein

Previously unvaccinated individuals may be given the BCG

392
Q

Mantoux test: 6 -15 mm

A

Positive - hypersensitive to tuberculin protein

Should not be given BCG. May be due to previous TB infection or BCG

393
Q

Mantoux test: >15 mm

A

Strongly positive - strongly hypersensitive to tuberculin protein
Suggests tuberculosis infection.

394
Q

How can you get a rapid test result for TB?

A

Nucleic acid amplification tests (NAAT)
allows rapid diagnosis (within 24-48 hours)
more sensitive than smear but less sensitive than culture

395
Q

What is scrub typhus?

A

caused by Orientia tsutsugamushi

396
Q

Features of scrub typhus?

A

black eschar at site of original inoculation
relative bradycardia despite fever

397
Q

Management of typhus?

A

Doxycycline

398
Q

Side effect of vancomycin?

A

nephrotoxicity
ototoxicity
thrombophlebitis
red man syndrome; occurs on rapid infusion of vancomycin

399
Q

What do you get the Marburg virus from?

A

bats / caves

400
Q

Councilman bodies (inclusion bodies) may be seen in the hepatocytes

A

Yellow fever

401
Q

Features of yellow fever?

A

sudden onset of high fever
rigors
nausea & vomiting
Bradycardia may develop

A brief remission is followed by jaundice, haematemesis, oliguria

402
Q

Treatment of enteric fever

A

Ciprofloxacin

403
Q

post kala azar dermal leishmaniasis (PKDL)

A

chronic skin condition that arises after the treatment of visceral disease.
often presents with erythematous or hypo-pigmented macules that may progress to become nodular. Clinically the lesions look very similar to pityriasis versicolour,

404
Q

Treatment for typhus?

A

Doxycycline is typically used in the management of typhus

405
Q

scrub typhus?

A

Scrub typhus: black eschar, maculopapular rash, fever, headache

406
Q

Treatment of mycoplasma pneumonia?

407
Q

Treatment for genital herpes ?

A

Oral acyclovir

408
Q

Pregnant + chlamydia?

A

pregnant then azithromycin, erythromycin or amoxicillin may be used

409
Q

Live attenuated vaccines?

A

Yellow Fever, BCG, Oral Polio and Varicella

410
Q

Influenza + severe immunocomromise?

411
Q

Staph aureus positive blood culture, length of treatment?

A

Staphylococcus aureus bacteraemia (SAB) is a serious condition which may occur secondary to soft tissue, joint, bone, indwelling IV line or cardiac infection. It is treated with a minimum of two weeks IV flucloxacillin

412
Q

Retro-orbital headache, fever, facial flushing, rash, thrombocytopenia in returning traveller

413
Q

young man presents with a symmetrical rash on his trunk, palms, and soles

414
Q

What is the name for bed bugs?

A

Cimex hemipteru

415
Q

Duration of Lyme disease treatment?

416
Q

Diagnosis of typhus is through blood culture

417
Q

HIV+TB treatment for tb?

A

rifabutin, isoniazid, ethambutol and pyrazinamide

rifampicin not need as already on taking a protease inhibitor

418
Q

Incubation of plasmodium falciparum?

419
Q

Incubation of plasmodium vivax?

A

12-17 days

420
Q

Incubation of chikungunya?

A

2- 12 days

421
Q

Dengue fever incubation?

A

2- 10 days

422
Q

Immunocompromised + measles exposure?

A

Provide immunoglobulin urgently

423
Q

When patient is admitted with ? TB what test should be done as will give a quick result?

A

Quantiferon TB

424
Q

Antibiotics in necrotising fascitis?

A

Tazocin and clindamycin

425
Q

What is the blood abnormality in Dengue and chikungunya?

A

Lymphopaenia
Thrombocytopaenia

426
Q

What is the most ocmmon type of necrotising fascitis?

A

Type 1
Strep pyogenes, clostrium difficult, and e coli

427
Q

What are the two forms of trypanosomiasisomiasis?

A

African trypanosomiasis
American trypanosomiasis

428
Q

Causative organism of African trypanososomiasis?

A

Trypanosoma gambiense in West Africa and Trypanosoma rhodesiense in East Africa.

429
Q

How is African trypanososomiasis caught?

A

tsetse fly.

430
Q

Features of african trypanososomiasis?

A

Trypanosoma chancre - painless subcutaneous nodule at site of infection
intermittent fever
enlargement of posterior cervical lymph nodes
later: central nervous system involvement e.g. somnolence, headaches, mood changes, meningoencephalitis

431
Q

Treatment of African trypanososmiasis?

A

early disease: IV pentamidine or suramin
later disease or central nervous system involvement: IV melarsoprol

432
Q

What is the other form of Amercain trypanososmiasis?

A

American trypanosomiasis, or Chagas’ disease

433
Q

What is sleeping sickness?

A

African trypanosomiasis

434
Q

Features of chugs disease ?

A

acute phase although a chagoma (an erythematous nodule at site of infection)
myocarditis may lead to dilated cardiomyopathy (with apical atophy) and arrhythmias
gastrointestinal features includes megaoesophagus and megacolon causing dysphagia and constipation

435
Q

Pregnant + influenza?

436
Q

TB meningitis?

A

vague headache, lassitude, anorexia and vomiting.
diplopia, papilloedema and hemiparesis and seizures

437
Q

Treatment of TB meningitis?

A

isoniazid, rifampicin, pyrazinamide and steroids.

438
Q

What should be avoided in TB meningitis?

A

Ethambutol

439
Q

Rabies wound + Not sought medical attention?

A

Give immunoglobulin
Give complete vaccination schedule

440
Q

Treatment of choice for systemic salmonella enteric ( typhoid) ?

A

Cefotxaime
Or
Ciprfo

441
Q

HBeAG positive hepatitis B - treatment?

A
  1. Interferon
  2. Tenofovir
    If people cannot tolerate tenofovir then use telbivudine
442
Q

Antigens of Hepatitis B ?

A

HBeAG - first antigen detected, active infection
HbsAG - active infection
anti-HBs - recovery and immunity from hepatitis B virus infection
anti-HBc - acquired infection
IgM anti-HBc - recent infection

443
Q

Epistaxis + bleeding + fevers + equator africa

A

Yellow fever

444
Q

Epistaxis + bleeding + fevers + south asia?

445
Q
A

Leishmaniasis

446
Q

Can viral haemorrhagic fever cause DIC?

447
Q

Congo + flu-like symptoms from 3-7 days + painful lymphadenoapthy groin / axilla

A

Ysersinia pestis

448
Q

What is the pneumococcal vaccine that is used?

A

23 unconjugated valent pneumococcal vaccine

449
Q

Inclusion bodies in colonic mucosa?

A

Think viral
CMV

450
Q

Efavirenz toxicity?

A

cause neuropsychiatric toxicity +psychosis
Myelosuppressive
disturbing dreams and other cognitive disturbances in 50% of patients in the first month of treatment.

451
Q

Acabavir side effect?

A

Hypersensitivity reaction
specific allele at the human leukocyte antigen B locus, HLA-B*57:01.

452
Q

What malaria causes relapsing disease?

A

Plasmodium vivax
Plasmodium ovale

453
Q

Malaria more common in india?

454
Q

Malaria more common in africa?

455
Q

Malaria south east asia?

456
Q

Most common complication of mumps?

457
Q

What is the human herpes virus 5 ?

458
Q

What does viral tropism do in HIV?

A

The test for viral tropism determines which of these co-receptors HIV will bind to.

459
Q

In a dural tropic HIV what medication will not work?

460
Q

Pulmonary involvement + partially acid fast bacilli

A

Nocardiosis
Occurs in immunosuppressed

461
Q

Treatment of Nocardiosis

A

Trimethroprim / sulfamethoxole + amikacin + ceftriazone

462
Q

Diagnosis TB: Sputum vs Lavage?

A

Lavage wins

463
Q

South america + nasal superficial ulceration?

A

Leishmanisis brazilians
skin lesions may spread to involve mucosae of nose, pharynx etc

464
Q

Calabar swellings: transient, non-erythematous, hot swelling of soft-tissue around joints

465
Q

Treatment of klebsiella pneumoniae ?

A

polymyxins (e.g. colistin), tigecycline, fosfomycin or aminoglycosides (e.g. gentamicin)

466
Q

Treatment for chagas?

A

Benzdiazole

467
Q

What does ESBL needd treated with?

A

resistant to penicillins and cephalosporins and as such the carbapenem class of antibiotics are typically first-line although nitrofurantoin or fosfomycin are also frequently effective.

468
Q

Treatment of TB isoniazid resistant ?

A

RPE + P for 2 months

R+E for final 4months

469
Q

Test for norovirus?

A

Faecal / vomit serology

470
Q

Deprived + measles?

A

Two shots of vitamin A

471
Q

Multi resistant TB drug and disease duration?

A

multi-drug resistant TB requires 18-24 months of at least 5 drugs.

472
Q

What is Yaws?

A

chronic infection that affects mainly the skin, bone and cartilage.

Treponema pertenue, a subspecies of Treponema pallidum that causes venereal syphilis. However, yaws is a non-venereal infection.

a single skin lesion develops at the point of entry of the bacterium after 2-4 weeks. This nodule can break down into an exudative ulcer. Without treatment, secondary yaws can occur, resulting in multiple lesions appear all over the body, more commonly over the face, trunk, genitalia and buttocks. Later on in the disease course, widespread bone, joint and soft tissue destruction can occur.

473
Q

Vaccines required in splenectomy ?

A

if elective, should be done 2 weeks prior to operation
Hib
meningitis A & C
annual influenza vaccination
pneumococcal vaccine every 5 years

474
Q

Difference between schistosome mansoni and S japonicum, S. mekongi and S. intercalatum
AND haemobium

A

S. mansoni and S japonicum, S. mekongi and S. intercalatum produce eggs that can invade the bowel wall causing an intense inflammatory reaction that gives rise to loose bloody stools. Eggs can also migrate to liver through the portal venous system where they can elicit a granulomatous fibrosing reaction

S. haematobium on the other hand leads to granulomatous inflammation, ulceration of the vesicle and ureteral walls. Subsequent fibrosis can cause bladder neck obstruction, hydroureter and hydronephrosis.

475
Q

Lyme disease ECG?

A

ECG shows a complete heart block with complete dissociation of the QRS complexes from the p waves

476
Q

Treatment of cryptococcal meningitis in HIV?

A

IN amphoterasine + flucytosine

477
Q

Treatment for brucellosis ?

A

Doxycycline + rifampicin for 6 weeks

478
Q

Diagnosis of leptospirosis?

A

Serum serology

479
Q

Neurocysterocus?

A

A CT scan subsequently showed cystic and calcified lesions within the brain and mild hydrocephalus
likely his +ve

480
Q

Best test to diagnose trpansomiasis?

A

lumbar puncture

481
Q

filariform larvae

A

stronyloides

482
Q

Dietary advice for patients with giardiasis?

A

avoid dairy

483
Q

TB close contact

A

If asymptomatic and younger than 65 years then test for latent TB. If Mantoux-negative and unvaccinated then offer vaccination. If at risk of HIV then test for HIV first.
If asymptomatic and older than 65 years then assess with a chest X-ray.

484
Q

Advice pregnancy + zika?

A

Avoid becoming pregnant 8 weeks after travel

485
Q

HLA B*5701 + HIV

A

Cannot have abacavir

486
Q

Unwell vet with fever, malaise, arthralgia and lower back pain

A

Brucellosis

487
Q

Peginterferon alpha 2a is the first line treatment for adults with HBeAg-negative chronic hepatitis B with compensated liver disease. Tenofovir disoproxil or entecavir are second line treatment in those who have detectable HBV DNA after treatment with peginterferon alpha 2a.

A

Peginterferon alpha 2a is the first line treatment for adults with HBeAg-negative chronic hepatitis B with compensated liver disease. Tenofovir disoproxil or entecavir are second line treatment in those who have detectable HBV DNA after treatment with peginterferon alpha 2a.

488
Q

Traveller diarrhoea + Immunosuppressed + prophylaxis?

A

Cipfrofloxacin can be used

489
Q

look at his drugs bit

490
Q

risk factor for new fasc?

A

chicken pox

491
Q

African Sleeping Sickness or African Trypanosomiasis. Trypanosoma gambiense is more common than Trypanosoma rhodesiense in patients from West Africa, such as Nigeria.

A

African Sleeping Sickness or African Trypanosomiasis. Trypanosoma gambiense is more common than Trypanosoma rhodesiense in patients from West Africa, such as Nigeria.

492
Q

PPI can disrupt lower the efficacy of atazanavir

A

PPI can disrupt lower the efficacy of atazanavir

493
Q

Vancomycin Resistant Enterococcus (VRE) can be treated with linezolid, daptomycin and tigecycline

A

Vancomycin Resistant Enterococcus (VRE) can be treated with linezolid, daptomycin and tigecycline

494
Q

Risk of vertical transmission for hepatitis C is 6%

A

Risk of vertical transmission for hepatitis C is 6%

495
Q

slow larva = CLM = Ancyclostoma =skin only
rapid larva = CLC = Strongyloides =skin, bowels, lungs

A

slow larva = CLM = Ancyclostoma =skin only
rapid larva = CLC = Strongyloides =skin, bowels, lungs

496
Q

Ancyclostoma braziliense.
treatment?

A

albendazole or ivermectin.

497
Q

test of eradication for strongyloids?

498
Q

Treatment of Entamoeba histolytica (hydatid cyst)

A

Metrondiazole

499
Q

Delayed septic joint + gram positive ?

MRCP: Infectious Diseases (15 decks)

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