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MRCP Part 1 > MRCP Infectious disease > Flashcards

MRCP Infectious disease Flashcards

1
Q

Treatment for uncomplicated P.vivax malaria

A

Artemisinin ACT
or chloroquine

+ primaquine (for hypnozite)

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2
Q

Q fever hallmarks

A

Coxiella burnetti
intracellular organism - culture negative
route: inhalation/aerosol/unpasteurised milk
sx: fever, headache, malaise, flu like
cx: pneumonia, hepatitis, myocarditis, endocarditis
mx: doxycycline

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3
Q

HACEK group

A

Haemophilus aphrophilus,
Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis,
Eikenella corrodens - gram -ve rod
Kingella kingae

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4
Q

Investigation for gonorrhea in men and women

A

men- urine NAAT
women- endocervical NAAT swab

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5
Q

What is loa loa also known as

A

African **eye worm **(nematode)

itchy skin lesions confined to extremities of arms and legs

mx: DEC for loiasis

note: severe case —> albendazole (as DEC may trigger encephalitis)

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6
Q

Which schistosomiasis subtype cause abdo pain and bloody diarrhoea

A

Schistosomiasis manosi

reside in mesesnteric veins

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7
Q

Vector of schistosomiasis

A

water snail

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8
Q

Why is chlamydia trachomatis not seen in gram stain

A

too small to be visualised

gram -ve

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9
Q

what does gonorrhoea look like on gram stain

A

coffee bean shaped gram -ve dipplococci

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10
Q

type of microscopy for syphillis

A

dark field microscopy

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11
Q

Tapeworm diagnosis

A

proglottid segments shed by worms used to diagnose

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12
Q

Source of tape worm

A

beef- taenia saginata

pork- taenia solium

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13
Q

Which tapeworm causes brain infection

A

taenia solium from pork

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14
Q

Notifiable disease

A

Malaria

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15
Q

Fungal infection 2 groups

A

Dermatophytes
- trichophyton
- tinea pedis etc

yeasts
- candida
- pityriasis versicolor

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16
Q

What organism causes ringworm like rash with scaly red border, spreading down inner thigh

A

tinea cruris (due to T. rubrum)

jock itch

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17
Q

What fungus cause pityriasis versicolor

A

Malassezia furfur

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18
Q

What is the name of pubic lice

A

Phthiriasis pubis

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19
Q

What is jarisch herxheimer reaction?

A

Abx for spirochete infection
- rapid toxin release from bacteria
- causing sepsis like sx

Lyme
Syphyllis
Leptospirosis

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20
Q

Which live vaccine should pregnant people avoid

A

yellow fever

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21
Q

Most common pathogen causing bacterial meningitis in immunocompromised adults

A

Listeria - in cancer and elderly

Haemophilus
Nesseria gonorrhoea

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22
Q

Toxic shock syndrome hallmarks

A

tampon use
severe inflammatory response to staph toxins TSST-1
DIC- due to factor 12
XS bradykinin- low BP

Mx:
clindamycin and vancomycin

Staph aureus or GAS

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23
Q

Which malaria causes severe disease and death

A

falciparum

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24
Q

Antibiotic of choice for typhoid fever in pregnancy

A

ceftriaxone

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25
Q

Aspergilloma vs TB

A

Aspergilloma more acute

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26
Q

Chancroid hallmark

A

penile ulcer painful with ragged edge
Lymphadenopathy
haemophilus duoneyi (gram -ve rod)
STI

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27
Q

Painless genital ulcer

A

LGV
primary syphillis

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28
Q

TB

A

weight loss
haemoptysis

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29
Q

Toxoplasmosis transmission

A

undercooked meat of infected sheep and goat

cats

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30
Q

Hantavirus pulmonary syndrome

A

rodent-borne viruses

pulmonary oedema

renal syndrome

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31
Q

Rocky mountain spotted fever hallmarks

A

outdoor exposure
tick bite
Rickettsia rickettsii
fever, headache, myalgia
macular rash hands and feet —> to trunk

note spotten fevers are named after place i.e mediterranean

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32
Q

Bacterial vaginosis hallmarks

A

Gardnerella vaginalis
fishy discharge
Douching
Alkaline pH

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33
Q

Trichomonas vaginalis

A

STI
Frothy vaginal discharge
(yellow-green)
strawberry cervix

mx: metronidazole 5-7 days

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34
Q

Candida thrush

A

thick cottage cheese discharge

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35
Q

Cervical cancer HPV

A

16 and 18

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36
Q

Which HPV vaccines exist

A

16 and 18 (cervical ca)
6 and 11 (genital wart)

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37
Q

What is ORF

A

poxvirus
sheep or goat contact
nodular lesion that ulcerate
lymphadenopathy

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38
Q

Lyme disease hallmark

A

Borrelia burgdorferi
erythema migrans
tick bite

can cause nerve palsy/meningitis/arthritis
AV block-> collapse

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39
Q

Which ART is associated with renalstone?

A

Indinavir

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40
Q

What is the management for chlamydia

A
  1. doxycycline

Note: azithromycin in PREGNANCY

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41
Q

What is the diagnosis of choice for malaria

A

thick and thin film

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42
Q

What is progressive multifocal leukoencephalopathy

A

JC virus
HIV immunocompromised
focal neurology motor
memory mood changes
MRI- multifocal white matter lesions- demyelination

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43
Q

E.coli that causes traveller’s diarrhoea

A

ETEC

enterotoxigenic
watery diarrhoea

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44
Q

E.coli that cuases dysentry

A

Enterohaemorrhagic

0157H7
HUS
Schistocyte in peripheral smear

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45
Q

Reactivated malaria subtypes

A

Vivax and Ovale

form hypnozoites in liver

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46
Q

Treatment for liver infected malaria

A

primaquine

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47
Q

5 plasmodium species

A

falciparum
vivax
ovale
malariae
knowlesi

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48
Q

Prophylactic abx for CD4 <200 in HIV to prevent opportunistic infx

A

co-trimoxazole

i.e PCP
Toxoplasmosis

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49
Q

Impetigo hallmarks

A

staph aureus
golden crust
treat with fusidic acid

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50
Q

Herpes zoster vs simplex

A

zoster- chicken pox and shingles

simplex
- HSV: cold sore, encephalitis, genital ulcer

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51
Q

HIV ART mneumonic

A

Roc and tide fuse (maraviroc and enfuvirtide)

protease inhibitor
- navir tease a pro

InTEGRase inhibitor
- RalTEGRavir

NNRTI:
- VIR (efaVIRenz)

NRTI (bine dine sine)
- tenofovir
- zidovudine
- rest of the drugs

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52
Q

Schistosomiasis types

A

haematobium - urinary and genial disease

mansoni- bowel and liver (kayatama disease
japonisum- bowel and liver
mekongi- bowel and liver
guineesis- bowel and liver

note latter 4 reside in mesenteric veins

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53
Q

Treatment for schitosomiasis

A

praziquantel

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54
Q

Vector for schistosomiasis

A

water snail for water fluke

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55
Q

S.aureus food poisoning

A

2-4 hr instant post ingestion
performed enterotoxin B in contaminated food

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56
Q

What is mycobacterium avium complex (MAC)

A

advanced HIV complication

CD4 <50

nontuberculous mycobacteria.

Mycobacterium avium-intracellulare infections or Mycobacterium avium complex

causing pulmonary disease

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57
Q

HIV opportunistic infection CD4 200-500

A

thrush (candida)
shingles (HZV)
hairy leukoplakia (EBV)
kaposi (HHV-8)

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58
Q

HIV opportunistic infection CD4 100-200

A

Crytosporidiosis (watery diarrhoea)
toxoplasmosis
PML (JC virus)
PCP
HIV dementia

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59
Q

HIV opportunistic infection CD4 50-100

A

Aspergillosis
oesophageal candida
Cryptococcal meningitis
primary CNS lymphoma (EBV)

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60
Q

HIV opportunistic infection CD4 <50

A

CMV retinitis
MAC

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61
Q

Treatment for artesunate resistant falciparum malaria (Uganda)

A

artemether-lumefantrine

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62
Q

Trypanosoma cruzi (Changas)

A

myocarditis
cardiomyopathy
cardiac failure

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63
Q

EBV hallmarks

A

sore throat
fever
malaise

cervical lymphadenopathy
splenomegaly
petechiae on soft palate
white exudate on tonsil

basically strep throat with rash

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64
Q

Investigation of choice for EBV

A

MONOSPOT TEST

(Heterophilic antibodies)

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65
Q

Anthrax hallmarks

A

Bacillus anthracis
2-5 days incubation
Ingesting raw meat

  • cutaneous- black eschar, lymphadenopathy, oedema
  • pulmonary- sore throat, fever
  • gastrointestinal- diarrhoea, abdo pain

Anthrax means BLACK in greek

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66
Q

Shigella route of transmission

A

faeco-oral

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67
Q

Leptospirosis occupation risk

A

sewage workers, farmers, vets or people who work in an abattoir

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68
Q

Leptospirosis 2 phases

A

Leptospiraemic
- myalgia
- petechial rash
- headache
- conjunctival redness

Immune -> leading to weil’s disease
- acute kidney injury
- hepatitis: jaundice, hepatomegaly
- aseptic meningitis
- splenomegaly

river bank RAT URINE

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69
Q

Diagnosis of schistosomiasis with haemturia

A

urine MCS

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70
Q

Otitis externa hallmarks

A

Pseudomona in diabetics - malignant otitis
s.aureus - simple otitis

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71
Q

Giardia hallmark

A

faeco-oral
protozooan
stool MCS

traveller diarrhoea, flatulence, weight loss (malabsorption)

tinidazole/metronidazole

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72
Q

Weil disease

A

Severe leptospira

pulmonary haemorrhage
hepatic failure
renal failure

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73
Q

Paramyxovirus causes….

A

mumps
viral meningitis
parotid swelling

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74
Q

Management for lyme

A

doxycyline first
if not amoxicillin

note: if hx suggestive of lyme no need for serology

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75
Q

Mediterranean spotted fever hall marks

A

Rickettsi corni

rash- eschar

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76
Q

Typhoid fever

A

Travellers- tropical disease
faeco oral

CONSTIPATION
headache
fever
rose spots (between nipple and umbilicus)

severe-> hepatosplenomegaly

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77
Q

Diptheria hallmark

A

Unvaccinated
corneybacterium bacterial toxin
fever SORE THROAT
pharyngitis with grey tonsil
heart block and heart failure

Notfifiable

DIP IN THE THROAT

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78
Q

Measles hallmarks

A

Podrome:
koplik spots (buccal white)
fever
conjunctivitis
cough

Followed by:
Rash behind ear or face spreading down

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79
Q

Features of primary syphillis

A

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)

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80
Q

Features of secondary syphillis

Secondary syphilis mneumonic: TWO
Trunk rash, warts, oral ulcers

A

systemic symptoms: fevers, lymphadenopathy

symmetrical rash on trunk, palms and soles

buccal ‘snail track’ ulcers (30%)

rash may become condylomata lata (painless, warty lesions on the genitalia )

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81
Q

Features of tertiary syphillis

A

gummas (granulomatous lesions of the skin and bones)

ascending aortic aneurysms

general paralysis of the insane

tabes dorsalis

Argyll-Robertson pupil

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82
Q

TB sputum MCS

A

Zeihl neelson stain for AFB

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83
Q

Why is primaquine and chloroquine given in plasmodium VIVAX and OVALE

A

Primaquine
- clears hypnozites

Chloroquine
- treating symptomatic erythrocytic stage of malaria (anaemia and swining fever)

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84
Q

Organism causing IE in IVDU

A

Staph aureus

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85
Q

IVDU and new TR

A

endocarditis

TR- PSM + giant CV waves in JVP

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86
Q

Antibiotics that cause c.diff

A

CLINDAMYCIN
CIPROFLOXACIN
CARBAPENEM
Cephalosporins
CO-AMOX

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87
Q

Chancre

A

painless ulcer on site of sex

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88
Q

When should ART be started and prophylaxis for PCP

A

ART as soon as possible

PCP prophylaxis when CD4 <200

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89
Q

Strongyloides hallmark

A

nematode
rash on buttock
eosinophilia
abdo pain
diarrhoea
urticaria

Mx: ivermectin or albendazole

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90
Q

Actinomyosis hallmarks

A

fungal infection (anaerobic)
endogenous flora
from tooth extraction
lumpy jaw
sulfur granules

prolonged amoxicillin

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91
Q

Nocardiasis hallmarks

difficult to differentiate from actinomyoces spp

A

Gram-positive filamentous rod
paraffin bait to culture
- uses as carbon source for growth
painless swelling —> ulceration
Mx: cotrimoxazole

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92
Q

oocytes on ZN Stain

A

Cryptosporidium HIV related diarrhoea

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93
Q

Dengue fever hallmarks

A

Flavivirus
Mosquito transmission

generalised maculopapular rash
low plt and wcc
fever

viral infection that can progress to viral haemorrhagic fever

BREAK BONE FEVER

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94
Q

Warning signs of dengue and management

A

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

Mx: supportive

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95
Q

What is loeffler syndrome

A

Strongyloide larvae migrate to the lungs a pneumonitis

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96
Q

when is co-trimoxazole used

A

PCP in HIV

Cyclospora cayetanensis
(traveller diarrhoea)

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97
Q

How long would HIV becomes AIDS if left untreated

A

10 years

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98
Q

What is the tirad of HUS and what is the diagnostic method

A

E.coli 0157 SHIGA TOXIN

  1. AKI
  2. MAHA (coombs+shistocyte fragment RBC)
  3. Thrombocytopenia

Stool MCS for e.coli

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99
Q

Diagnosis and management of MAC

A

blood cultures

mx:
Mycobacterium
Azithromycin
Clarithromycin

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100
Q

dendritic corneal ulcer

A

HSV keratitis

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101
Q

Which RBC receptor does malaria vivax bind to?

A

Duffy

note: people with lack of this receptor are resistant to vivax infection

note: people with sickle, thalassaemia and G6PD are resistant to malaria

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102
Q

First line treatment for toxoplasmosis

A

pyrimethamine and sulfadiazine and folic acid

note: pyrimethamine is folate antagonist

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103
Q

What is the mechanism of action of vancomycin

A

prevents formation synthesis of polymers for bacterial cell wall

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104
Q

What is the mechanism of action of gentamicin

A

binds irreversibly to ribosome subunit preventing protein synthesis

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105
Q

Mechanism of action of metronidazole

A

causes oxidative damage to bacterial DNA

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106
Q

M

Mechanism of action of macrolide and clindamycin

A

inhibitrs ribosomal translocation

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107
Q

What is the adverse reaction of vancomycin

A

red man syndrome

flushing of face neck torso

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108
Q

What cancers are HPV 16 and 18 associated with

A

cervical
anal

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109
Q

Which antibiotic should be added on top of ceftriaxone for listeria meningitis?

A

Amoxicillin/ampicillin

over 60 or immunosuppressed

110
Q

Which virus causes viral meningitis (school teacher)

A

enterovirus species

111
Q

What is the most effective way in reducing risk of HIV in newborn child

A

post natal zidovudine to the baby

112
Q

Anopheles mosquito

113
Q

Aedes mosquito

A

dengue
yellow fever
zika

114
Q

Orienta tsutsugamushi causes

A

scrub typhus

causes eschar on bite site
fever, headache, joint pain
lymphadenopathy localised

tick (Chigger) bite. campers in australia

115
Q

Key travel related infection

A

Haemorrhagic fever
Rickettsial
Lyme
HIV
Typhoid
Dengue

116
Q

Main sub saharan african infections

A

plasmodium falciparum
HIV
rickettsia
ebola

117
Q

Main south asian infection

A

falciparum, vivax and ovale
dengue
typhoid (salmonella)
HIV

118
Q

Tetanus hallmarks

A

acute neurological
- muscle spasm
- autonomic dysfunction

Due to neurotoxin from c.tetani bacteria

urgent anti-tetanus immunoglobulin !!!

119
Q

Typhoid fever hallmarks

A

fever
bradycardia
rose spots (macularpapular rash on chest and abdo)
GI bleed from ulcered peyer’s patch in ileum
abdo pain
—-> hepatosplenomegaly

Mx: IV ceftriaxone

120
Q

Diptheria management

A

ANTITOXIN

+ + macrolide/benpen

121
Q

Side effect of tenofovir

A

kidney disease

122
Q

COPD/immunocomprosed vaccination

A

yearly influenza
pneumococcal 5 yearly

123
Q

Brucellosis hallmark

Bruisedddd Bruce

A

Zoonosis: Brucella spp

farm animal/unpasteurised milk

FARMERS!!!

Presentation:
ache and pain
fever
weight loss
depression
hepatosplenomegaly
LYMPHADENOPATHY

Mx:
- doxy and rifampicin for 6 weeks
- and aminoglycoside for 2 weeks

124
Q

Management of brucella

A

doxycycline
rifampicin
gent/cotrimox

triple therapy for 6 weeks

125
Q

Malaria prophylaxis drug

A

doxycycline
malarone
primaquine

Note: give malarone in epileptic as others reduces seizure threshold

126
Q

Investigation of choice to confirm new HIV

A

ELISA for HIV antibody and p24 antigen test

note: PCR is for viral load in monitroing

127
Q

Abx of choice for ?meningitis in over 60 years and penicillin allergy

A

chloramphenicol
with co-trimoxazole

128
Q

What does increasing PR interval suggest in infective endocarditis

A

uncontrolled infection
need urgent surgery

129
Q

Incubation periods for common organisms

A

1-6 hrs: Staphylococcus aureus, Bacillus cereus
12-48 hrs: Salmonella, Escherichia coli
48-72 hrs: Shigella, Campylobacter
> 7 days: Giardiasis, Amoebiasis

130
Q

Catch scratch disease

A

Baronella henselae

cat scratch or bite

lymphadenopathy
self limiting

tame hensel cat

131
Q

Chlamydia serotypes

A

Lymphogranuloma venereum (LGV) is caused by Chlamydia trachomatis serovars L1, L2 and L3
- proctocolitis

‘Normal’ Chlamydia resulting in urethritis and pelvic inflammatory disease is caused by Chlamydia trachomatis serovars D through K.

132
Q

Epidemic typhus

A

Rickettsia prowazekii
measle like eruption
rural poor hygiene

133
Q

Salmonella typhi organism type

A

gram -ve rod

134
Q

What is the way to contract strongyloides

A

soil indwelling

walking barefooted is risk

vague abdo pain, eosinophilia, malabsorption

136
Q

What defines treatment failure of MDRTB?

A

positive cultures after 4 months of therapy

137
Q

Salmonella vs Shigella food

A

Salmonella- meat/egg/poultry

Shigella-faeco-oral i.e street fruit etc

138
Q

Botulism

A

eating contaminated food (e.g. tinned) or intravenous drug use

neurotoxin (exotoxin) often affects bulbar muscles and autonomic nervous system

triad: blurred vision, dysphagia, muscle weakness

139
Q

Neisseria meningitidis grams stain

A

gram -ve cocci

140
Q

Listeria meningitis gram stain

A

gram +ve rod

141
Q

strep pneumonia meningitis gram stain

A

gram -ve cocci

142
Q

EBV hallmarks

A

glandular fever/mononucleois

fever, pharyngitis, tender LN

143
Q

Parvovirus B19 hallmark

A

slapped cheek
children

144
Q

Mumps hallmarks

A

epididymo-orchitis
meningism

145
Q

Rubella hallmarks

A

maculopapular rash from face to whole body
lymphadenopathy: suboccipital and postauricular

146
Q

Life cycle of malaria

A

hypnozoites- dormant liver stage of vivax and ovale -> relapse
priaquine and chloroquine given for vivax and ovale to eradiate hypnozoite and prevent relapse

note: falciparum treatment: fansidar (pyrimethamine + sulfadoxine) or tetracycline given after quinine therapy

147
Q

Pre or Post Splenectomy immunisation

4-6 weeks or 2 weeks

A

pneumococcal vaccine
haemophilus ingluenzae B
Meningococcus

risk of encapsulated sepsis

148
Q

Management of cryptospordium in HIV patients and non HIV patients

A

HIV: start ART

Non HIV: supportive

149
Q

Which live vaccine should be avoided in HIV patients

A

BCG - risk of TB

150
Q

Chronic diarrhoea, weight loss, arthralgia, hyperpigmentation of skin

A

Whipple’s

151
Q

Side effect of NNRTI

A

wide spread rash
hepatitis
night night (vivid dreams)

152
Q

Side effect of NRTI

A

lipoatrophy

B RAMP

Bone marrow supp
Rash
Acidosis
Megaloblastic anaemia (zdv)
Peripheral neuropathy
Pancreatitits

153
Q

Which statin is preferred in hyperlipidaemia in HIV patients

A

pravastatin (not CYP450 dependent)

154
Q

What is the test for contact tracing for TB exposure

A

mantoux

screen for latent TB

155
Q

When is IGRA test used

A

if mantoux test is +ve
for active TB

156
Q

What are the symptoms of seroconversion of HIV

point at which the body produces antibodies to HIV

A

fever
malaise
lymphadenopathy
generalised rash

157
Q

Eikenella corrodens gram stain

A

gram -ve rod

158
Q

What is the cause of multiorgan complication of diptheria

A

bacterial exotoxin

159
Q

Dermatophyte that produces microconidia (spores)

A

Trichophyton spp

athlete’s foot

160
Q

Vector for african trypanosomiasis

A

tsetse fly

161
Q

Hallmark leishmania (visceral and cutaneous)

A

sandflies
days to months incubation
- erythematous nodule bite site
- golden crust forms

Cutaneous
- skin biopsy
- treat with sodium stilbogluconate

Visceral (kala-azar)
- bone marrow/lymph node/splenic biopsy
- treat with amphotericin B, sodium stilbogluconate

162
Q

Side effect of protease inhibitors

A

HIL
hyperlipidaemia/hyperglycaemia
gI intolerance
lypodystrophy

especially ritonavir

note: rifampicin decreases PI concentration

163
Q

Side effect of integrase inhibitor

A

nausea
diarrhoea
headache

Hypercholesterolaemia

164
Q

Encapsulated bacteria

A

NHS

neisseria
haemophilus
strep

165
Q

penile ulcers

A

Painful
- Chancroid (thailand sex worker) - gram neg rod
- HSV (multiple ulcer + tender LN + recurrence) - no growth on gram stain

Painless
- syphillis (single ulcer)
- LGV (regional LN)
- granuloma inguinale (donovanosis) - painless spreading friable ulcer

166
Q

Treatment for acute epididymo-orchitis

A

> 35 and not STI (enteric cause)
- olfloxacin first line

<35 and STI cause
- ceftriaxone

167
Q

Legionella hallmarks

A

hyponatraemia
deranged LFT
diarrhoea

168
Q

Malaria prophylaxis in epileptic

A

give malarone

169
Q

ALA (amoebic liver abscess) treatment

due to entamoeba histolytica

A

metronidazole or tinidazole

170
Q

Hantavirus endemic in…

A

south korea
scandinavia

hanta hangook

171
Q

HIV - FBC abnormalities

A

Normocytic anaemia
Thrombocytopenia
Macrocytosis with ART

172
Q

Prophylaxis for meningococcus contact

A

cipro first line

alternative: azithromycin

173
Q

Management for gonorrhoea

A

IM ceftriaxone single dose
alternative:
- PO cefixime and azithromycin

174
Q

Management for chlamydia

A

doxycycline

alternative:
azithromycin or erythromycin

Note: doxy and olfloxacin CI in pregnancy

175
Q

HIV oesophageal candidiasis management

A

PO fluconazole 14 days

176
Q

How does early viral meningitis differ from late presentation

A

early may be polymorphic
late is lymphocytic

177
Q

Listeria meningitits

A

Lymphocytic

178
Q

Partially treated bacterial meningitis…

A

present with lymphocytic meningitis

179
Q

What is low CSF glucose

A

<60% of serum

180
Q

Treatment of TB meningitis

A

RIPE + streptomycin

like MDRTB

NOTE: ZN stain may be -ve in CSF due to small amount

181
Q

Parvovirus 19 in adults seen in…

A

sickle cell anaemia

symmetrical polyarthritis
aplastic crisis

182
Q

Treatment for dengue

A

supportive

183
Q

How does hep B serology differ between recovered hep B vs hep B carrier

A

hep B carrier still has surface ANTIGEN

Both has hep B core IgG

184
Q

Management of EBV

A

supportive

avoid contact sport in first month due to risk of splenic rupture

185
Q

Treatment of toxoplasmosis

A

if pregnant/newborn/immunocompro

pyrimethamine and sulphadiazine

185
Q

CMV transmission by..

A

direct bodily fluid
transfusion
transplant
immunocompromised

186
Q

Adult bacterial meningitis caused by…

A

neisseria
strep pneumonia

187
Q

Meningococcal meningitis caused by..

A

neisseria meningitides

188
Q

how should deranged LFT in anti TB treatment be managed

A

stop RIPE

once LFT normalised re-introduce in order of IRP

189
Q

What does strep pyogenes cause

A

cellulitis
nec fasc

190
Q

Chronic hep B management with decomp CLD

191
Q

Leprosy hallmark

A

Mycobacterium leprae
granulomatous of peripheral nerve
Sensory loss–> burns
skin biopsy: multiple acide alcohol fast bascilli
Mx: rifampicin, dapsone, clofazimine

192
Q

How is Toxoplasma contracted

A

cat faeces

193
Q

How is cryptococcus contracted

A

bird faeces

194
Q

Cryptococcal meningitis management…

A

amphotericin B with fluconazole

195
Q

Brucella gram stain

A

-ve coccobacilli

196
Q

Cholera hallmarks

A

sudden onset
profuse diarrhoea
rice water stool
shell fish/contaminated water

197
Q

Most common cause of treatment failure in HIV

A

pooor compliance

198
Q

In needle stick injury with patient infected with hep C…

A

monthly hep C PCR surveillance

if positive then treat with inteferon

199
Q

pneumocytis jirovecii pneumonia hallmarks

A

IVDU/HIV
lymphopenia
high LDH
desat on exertion
ELEVATED 1,3 BDG (from cell wall)
CXR- bilateral interstitial shadowing

200
Q

Hep C hallmarks

A

HIV and alcohol associated

Ix:
- hep C antibody
- HCV PCR
- Genotype 1->4
- US if fibrosis seen
- fibroscan/biopsy

treatment:
- protease inhibitors (e.g. daclatasvir + sofosbuvir or sofosbuvir + simeprevir) with or without ribavirin are used

used to be IFN/peg IFN

201
Q

What is a complication of PCP

A

pneumothorax

203
Q

immunised hep B vs previous infection

A

vaccination: hep B surface antibody present but no core antibody

204
Q

What should be checked prior to primaquine treatment

A

screen for G6PD

risk of haemolysis with primaquine

205
Q

Malaria treatment

A

Severe falviparum/nonfalciparum
- IV artesunate

Non severe disease:
- oral ACT or chloroquine

206
Q

Percentage of untreated syphillis going onto tertiary syphillis

207
Q

Treatment of syphillis

A

STAT IM benzathine penicillin for primary

208
Q

Management of tropical sprue

A

tetracycline

(target bacterial overgrowth)

209
Q

Management for ESBL- ECOLI

210
Q

Teicoplanin affective against…

211
Q

Investigation of choice for tertiary neurosyphillis

A

TPPA (may be positive in yaws too)
VDRL test (non treponeme specific test)
- marker of disease activity

LP and syphillis serology

212
Q

Isolation protocol for MDRTB

A

negative pressure isolation room
- limit droplet spread

213
Q

EBV and cancer associations

A

nasopharyngeal carcinoma
Gastric cancer

213
Q

Menongococcal meningitis community SOS treatment

214
Q

When should steroid be given in meningitis

A

pneumococcal meningitis

215
Q

Shigella mode of transmission

A

person to person
bloody diarrhoea in nursery

216
Q

How long does TB bacteria take to double in numbers

217
Q

Tapeworm management

A

proglottids in faeces
Mx: niclosamide

218
Q

Ricketssial infection hallmarks

A
  1. Rocky mountain spotted fever
    - rickettsia rickettsii
    - USA
  2. mediterranean spotted fever
    - Rickettsi corni
  3. scrub typhus
    - Orienta tsutsugamushi
  4. african tick bite fever
    - rickettsia africae from africa

Sx: rash, lymphadenopathy, splenomegaly, eschar —> regional lymphadenopathy due to draining eschar
Mx: doxycycline

Mx: doxycycline

219
Q

Needle stick injury with HIV +ve patient

A

1 month of 3 ART

220
Q

What should be monitored whilst on IV quinine for severe falciparum

A

BM

(insulin release causing hypoglycaemia)

220
Q

Management of hep A

A

supportive
self limiting

221
Q

Lyme disease investigation

A

no need if classical target lesion and evidence of tick bite

If unsure—> ELISA

222
Q

P.vivax prevalent countries

A

sub saharan
central america
india

223
Q

p.ovale prevalent country

A

sub saharan africa

224
Q

Severe loiasis management

A

note: severe case —> albendazole (as DEC may trigger encephalitis)

225
Q

When is mebendazole indicated

A

pinworm
whipworm
roundworm
hookworm

226
Q

Thick and thin blood film

A

Thick: parasite burden
Thin: identify parasite

227
Q

Hallmark of malarial fevers

A

swining intermittent

228
Q

TB isolation rule

A

Pulmonary TB
Smear positive most infective
Likely/confirmed MDRTB

229
Q

Cerebral malaria is associated with…

A

falciparum
blackwater fefver- haemolysis, dark urine

230
Q

Anti-malaria prophylaxis…

A

still presents with risk of malaria infection

231
Q

Ancylostoma braziliense hookwork hallmarks

A

barefoot beach visits or direct soil contact.
moving skin rash
itchy

232
Q

Abx of choice for MRSA cellulitis

A

Vancomycin

or

teicoplanin

233
Q

CMV encephalitis treatment

A

Ganciclovir

234
Q

Bacillus cereus

A

cereal (Rice based dishes)
D+V within 8 hrs of eating
resolve in 1-2 days

235
Q

Mycoplasma pneumoniae

A

Cold agglutinin
erythema multiforme
dry cough

236
Q

What is the most common side effect of ribavirin for chronic hep c

237
Q

Ascariasis hallmarks

A

Ascaris lumbricoides
eggs hatch in small intestine
larvae enter liver to heart and lungs–> back to digestive tract where they mature into adult worm

Sx: asthma like symptoms

238
Q

Myconic keratitis

A

Fungal infection of eye
associated with trauma

ulceration in cornea

Antifungals- amphotericin B, itraconazole, natamycin

239
Q

Cause of hairy leukoplakia in HIV

240
Q

Which malaria prophylaxis can cause acute psychosis

A

mefloquine

241
Q

Rabies hallmarks

A

dog and bat bite

Presentation:
encephalitis
hallucination and confusion
hydrophobia (DOES NOT WANT WATER)

Mx:
- if already immunised: for 2 further vaccine
- if not immunised: for immunoglobulin and full vaccination

242
Q

Campylobacter from…

A

contaminated CHICKEN

CC

243
Q

Which vaccine is not a live vaccine

244
Q

CMV hallmarks

A

presents similar to EBV
in severe- pneumonitis, colitis, retinitis

245
Q

Investigation for cryptococcal stain

A

india ink stain

246
Q

Treatment for adult chicken pox

A

present within 72 hrs of onset of rash:
- oral aciclovir
- if severe then IV

248
Q

Where should you swab for gonorrhoea

A

mucosal site of symptoms

249
Q

HIV entry to cell

A

binds to CD4 primary receptor via gp120
with help of co-receptor CCR5

250
Q

Schistosomiasis acute presentation

A
  • swimmers’ itch
  • acute schistosomiasis syndrome (Katayama fever)
    fever
    urticaria/angioedema
    arthralgia/myalgia
    cough
    diarrhoea bloody
    eosinophilia
251
Q

Pregnant mum exposed to chicken pox

A

Urgent IgG
If -ve give VZIG

252
Q

Tropical sprue hallmarks

A

chronic diarrhoea
malabsorption
travel to tropics
steatorrhoea

253
Q

Animal bite

254
Q

Hepatitis vaccines

255
Q

Severe cellulitis management in penicillin allergy

A

Clindamycin

256
Q

Cause of hyatid disease (pulmonary and liver cyst)

A

Echinococcus granulosus

257
Q

Yellow fever hallmarks

A

viral haemorrhagic fever (also dengue fever, Lassa fever, Ebola).
zoonotic infection: spread by Aedes mosquitos
incubation period = 2 - 14 days
- mild flu-like illness lasting less than one week
- if severe jaundice, haematemesis may occur

258
Q

Staph aureus gram stain

A

coagulase positive
gram positive coccus in clusters

259
Q

Hep A presentation

A

bout of intense diarrhoea that resolves

then jaundice, nausea anorexia

260
Q

Immune reconstitution inflammatory syndrome in HIV and TB

A

Active TB patients who are immunocompromised -> no symptoms
HIV started on ART -> boost immune -> exaggerated response
also associated with cryptococcus and kaposi

Mx: steroids

261
Q

What is klebsiella granulomatis associated with

A

granuloma inguinale

262
Q

Treatment for Rickettsia

A

Doxycycline

Pregnant: chloramphenicol

263
Q

Chance of contracting HIV from needle stick

A

1/300 chance

264
Q

How does clarithromycin affect INR

A

increases INR as alters warfarin

265
Q

Prosthetic joint replacement septic arthritis causes…

A

early infection- s.aureus
chronic delayed- s.epidermidis

266
Q

Hand foot and mouth disease

A

coxackie virus
type 16
self limiting
kindergarden teacher

MRCP Part 1 (17 decks)

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