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Medicine and Surgery Mushkies > Passmed ID Mushkies > Flashcards

Passmed ID Mushkies Flashcards

1
Q

What is BV?

A

An overgrowth of predominantly anaerobic organisms e.g. Gardnarella vaginalis. This leads to a consequent fall in lactic acid producing aerobic lactobacilli, resulting in raised vaginal pH

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2
Q

What are Amsel’s criteria for BV?

A

3/4 of:

  1. Thin, white homogeneous discharge
  2. Clue cells on microscopy
  3. Vaginal pH > 4.5
  4. Positive whiff test (KOH –> fishy odour)
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3
Q

What is the management of BV?

A

Metronidazole 400mg BD for 7 days

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4
Q

What are some risks of BV in pregnancy?

A
  1. Increased risk of preterm labour
  2. LBW
  3. Choriomamnionitis
  4. Late miscarriage
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5
Q

What causes diphtheria?

A

Corynebacterium diphtheriae

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6
Q

How does diphtheria exert its deleterious effects?

A

Release exotoxin that inhibitis protein synthesis

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7
Q

How does diphtheria present?

A
  1. Grey diphtheric membrane on tonsils caused by necrotic mucosal cells
  2. Bulky cervical lymphadenopathy
  3. Systemic distribution –> necrosis of myocardial, neural and renal tissue
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8
Q

What bacterium is responsible for the most wound infections?

A

S. aureus

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9
Q

What is Truvada?

A

Emtricitabine/Tenofovir

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10
Q

What should all HIV pts with CD4 < 200/mm^3 receive prophylaxis against?

A

PCP with co-trimoxazole

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11
Q

What is the most common opportunistic infection in AIDS/

A

PCP

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12
Q

What is pneumocystis jirovecii?

A

A unicellular eukaryote, generally classified as a fungus but some consider it a protozoa

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13
Q

What is a common complication of PCP?

A

Pneumothorax

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14
Q

What are 3 extrapulmonary complications of PCP?

A
  1. Hepatosplenomegaly
  2. Lymphadenopathy
  3. choroic lesions
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15
Q

What investigation is often needed to demonstrate PCP?

A

BAL, as sputum often fails to show PCP

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16
Q

What is the management of PCP?

A
  1. Co-trimoxazole
  2. IV Pentamidine in severe cases
  3. Aerosolized pentamidine
  4. Steroids if hypoxic
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17
Q

What are supposedly surprisingly not notifiable diseases in the UK?

A

HIV and syphilis

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18
Q

What two infections are associated with a vaginal pH > 4.5?

A

Trichomonas vaginalis and BV

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19
Q

What is Trichomonas vaginalis?

A

A highly motile, flagellated protozoan

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20
Q

What are some features of Trichomonas vaginalis?

A
  1. Frothy, offensive, yellow/green discharge
  2. Vulvovaginitis
  3. Strawberry cervix
  4. pH > 4.5
  5. In men may cause urethritis
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21
Q

What is the management of trichomonas vaginalis?

A

2g Metronidazole single dose

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22
Q

What is the management of necrotising fasciitis?

A

IV Abx and immediate surgical debridement

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23
Q

How is necrotising fasciitis classified?

A

According to causative organism

  1. Mixed anaerobes and aerobes, the most common type, typically post-surgery in diabetics
  2. S. pyogenes
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24
Q

What are some features of necrotising fasciitis?

A
  1. Acute onset
  2. Painful, erythematous lesion
  3. Rapidly worsening cellulitis with pain out of keeping with physical featurss
  4. Extremely tender over infected tissue
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25
Q

What is the cause of erythema infectiosum?

A

Parvovirus B19

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26
Q

What are 2 complications of parvovirus B19 infection in pregnancy?

A

Hydrops fetalis and death

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27
Q

What is the infectivity of parvovirus B19?

A

Infectious from 3 weeks before the rash, no longer infectious once the rash appears

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28
Q

What kind of virus is parvovirus B19?

A

DNA virus

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29
Q

What can parvovirus B19 cause in immunosuppressed pts?

A

Pancytopenia

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30
Q

What can parvovirus B19 cause in SCD?

A

Aplastic crises (Parvo B19 suppresses erythropoiesis for about a week)

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31
Q

What is the main s/e of ethambutol, and as such what should be checked?

A
  1. Optic neuritis

2. Visual acuity should be checked before and after treatment

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32
Q

What are 3 s/e of isoniazid?

A
  1. Peripheral neuropathy
  2. Hepatitis
  3. Agranulocytosis
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33
Q

What are 4 s/e of pyrazinamide?

A
  1. Myalgia
  2. Arthralgia
  3. Hepatitis
  4. Hyperuricaemia (gout)
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34
Q

What are some s/e of rifampicin?

A
  1. Orange secretions
  2. Hepatitis
  3. Flu-like sx
  4. Potent CYP450 enzyme inducer
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35
Q

What must one consider in deterioration of a pt with Hep B?

A

HCC

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36
Q

What should surveillance of pts with diagnosed cirrhoses entail?

A

6m intervals:

  1. Abdominal US
  2. Measuring AFP levels
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37
Q

What is fulminant hepatitis?

A

A rare syndrome of massive necrosis of the liver parenchyma

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38
Q

What may cause fulminant hepatitis in a pt with Hep B?

A

Hep D co-infection

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39
Q

What kind of DNA is Hep B?

A

dsDNA hepadnavirus

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40
Q

What is incubation period of Hep B?

A

6-20 weeks

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41
Q

What are some complications of Hep B?

A
  1. Chronic hepatitis
  2. Fulminant liver failure
  3. HCC
  4. GN
  5. PAN
  6. Cryoglobulinaemia
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42
Q

What does an anti-HBs level >100 indicate?

A

Adequate response, no further testing required, receive booster at 5 years

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43
Q

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

A

Suboptimal response, one additional vaccine dose should be given, if immunocompetent then no further testing required

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44
Q

What does an anti-HBs level <10 indicated?

A

Non-responder, test for current or past infection, give 3 dose vaccine course again, if still fails to respond then HBIG required if exposed to virus

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45
Q

What are some management options for Hep B?

A

Pegylated IFN-a, tenofovir, entecavir, telbivudine

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46
Q

What happens if a pt takes metronidazole and ethanol?

A

A disulfiram-like reaction

  1. Head and neck flushing
  2. N&V
  3. Sweatiness
  4. Headaches
  5. Palpitations
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47
Q

What is the most common infection found in central line infections?

A

Staphylococcus epidermidis

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48
Q

Is S. aureus coagulase negative or positive?

A

Positive

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49
Q

Is S. epidermidis coagulase positive or negative?

A

Negative

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50
Q

What are two salient infections caused by S. epidermidis?

A
  1. Central line infections

2. Infective endocarditis

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51
Q

What are the components of the qSOFA score?

A
  1. RR > 22/min
  2. Altered mentation
  3. SBP < 100mmHg
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52
Q

When is a qSOFA score used?

A

Risk of morbidity and mortality in pts with sepsis not in IVCU

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53
Q

What is the sepsis 6?

A
  1. 3 in = oxygen, BS ABx, IV fluid (500ml crystalloid over less than 15 mins)
  2. 3 out = cultures, lactate, hourly urine output
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54
Q

What causes chancroid?

A

Haemophilus ducreyi

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55
Q

What causes syphilis?

A

Treponema pallidum

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56
Q

What causes lymphogranuloma venereum?

A

Chlamydia trachomatis

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57
Q

What causes granuloma inguinale?

A

Klebsiella granulomatis

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58
Q

What are some features of chancroid?

A
  1. Painful genital ulcers (sharply defined, ragged, undermined border)
  2. Unilateral, painful lymph node enlargement
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59
Q

How can you classify the features of syphilis?

A

Primary, secondary and tertiary stages

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60
Q

What are some primary features of syphilis?

A
  1. Chancre

2. Local non-tender lymphadenopathy

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61
Q

What are some secondary features of syphilis?

A

Occurs 6-10 weeks after primary infection

  1. Systemic = fevers, lymphadenopathy
  2. Rash on trunk, palms and soles
  3. Buccal ‘snail-track’ ulcers
  4. Condylomata lata (painless, warty lesions on the genitalia)
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62
Q

What are some tertiary features of syphilis?

A
  1. Gummas (granulomatous lesions on the skin and bones)
  2. Ascending aortic aneurysms
  3. General paralysis of the insane
  4. Tabes dorsalis
  5. Argyll-Robertson pupil
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63
Q

What is the incubation period of syphilis?

A

Between 9-90 days

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64
Q

What is used for treatment of thrush?

A

Fluconazole

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65
Q

What do HSV1 and HSV2 typically cause?

A
  1. HSV-1 = cold sores, oral lesions
  2. HSV-2 = genital lesions
  3. It is now known there is considerable overlap between the effects of the two!
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66
Q

What are some features of HSV?

A
  1. Primary infection may present with a severe gingivostomatitis
  2. Cold sores
  3. Painful genital ulceration
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67
Q

What is the management of gingivostomatitis secondary to HSV?

A

Oral aciclovir and chlorhexidine mouthwash

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68
Q

What is the management of cold sores?

A

Topical Aciclovir

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69
Q

What is the management of genital herpes?

A

Oral aciclovir

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70
Q

What are the signs of infection by HSV on microscopy of a pap smear?

A

3Ms

  1. Multinucleation
  2. Margination of the chromatin
  3. Moulding of the nuclei
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71
Q

What bacteria commonly causes reactivation of HSV, resulting in cold sores?

A

Streptococcus pneumoniae

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72
Q

What is the most common cause of CAP?

A

S. pneumoniae

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73
Q

What commonly causes CAP after the flu?

A

S. aureus

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74
Q

What is a classical cause of pneumonia in alcoholics?

A

Klebsiella pneumoniae

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75
Q

What is the formal term for a cold sore?

A

Herpes labialis

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76
Q

What causes giardiasis?

A

Giardia lamblia

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77
Q

What is Giardia lamblia?

A

A flagellated protozoan

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78
Q

How is Giardia spread?

A

Faeco-orally

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79
Q

How is Giardiasis treated?

A

Metronidazole

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80
Q

How can one diagnose Giardiasis?

A
  1. Stool microscopy for trophozoite and cysts are classically negative
  2. Duodenal fluid aspirates
  3. String tests (fluid absorbed onto swallowed string)
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81
Q

What blood findings are suggestive of legionella?

A
  1. Hyponatraemia

2. Deranged LFTs

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82
Q

What are some clinical features of Legionnaire’s disease?

A
  1. Flu-like symptoms
  2. Fever
  3. Dry cough
  4. Relative bradycardia
  5. Confusion
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83
Q

How is Legionnaire’s disease diagnosed?

A

Urinary antigens

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84
Q

What is the management of Legionnaire’s disease?

A

Erythromycin/clarirthromycin

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85
Q

What causes spread of malaria?

A

The female Anopheles mosquito

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86
Q

What are 4 different species of Plasmodium that cause malaria in man?

A
  1. Falciparum
  2. Vivax
  3. Ovale
  4. Malariae
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87
Q

What is a protective factor against malaria infection?

A

G6PDD

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88
Q

What is the most prevalent STI in the UK?

A

Chlamydia trachomatis

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89
Q

What percentage of young women in the UK have chlamydia?

A

10%

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90
Q

What is the incubation period of chlamydia?

A

7-21 days

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91
Q

In what percentage of men and women is chlamydia asymptomatic?1

A
  1. Women = 70%

2. Men = 50%

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92
Q

What are some features of chlamydia infection in women and men?

A
  1. Women = cervicitis (bleeding, discharge), dysuria

2. Men = urethral discharge, dysuria

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93
Q

What are some potential complications of chlamydia in women?

A
  1. PID
  2. Endometritis
  3. Increase incidence of ectopic pregnancies
  4. Infertility
  5. Perihepatitis (FHC syndrome)
  6. Reactive arthritis
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94
Q

What are some potential complications of chlamydia in men?

A
  1. Epididymitis
  2. Infertility
  3. Reactive arthritis
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95
Q

What is the investigation of choice for chlamydia?

A

NAAT

  1. Vulvovaginal swab in women
  2. Urine test in men
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96
Q

What age group is the national Chlamydia screening programme open to in the UK?

A

15-24 y/o

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97
Q

What is the abx management of chlamydia?

A

Doxycylcine (7d) or azithromycin (single dose)

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98
Q

What is the abx management of chlamydia in pregnancy?

A

Azithromycin 1g stat

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99
Q

Who should be contacted for men with urethral symptoms due to Chlamydia?

A

All contact since and in the 4 weeks prior to onset of symptoms

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100
Q

Who should be contacted for women and asymptomatic men with Chlamydia?

A

All partners from the last 6 months or the most recent sexual partner

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101
Q

How should contacts of confirmed Chlamydia cases be treated?

A

Treat then test

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102
Q

What should be pts with suspected meningococcal meningitis be given if in a GP surgery?

A

IM benpen

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103
Q

What is the management of meningitis?

A

IV cefotaxime

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104
Q

What is the management of Listeria meningitis?

A

IV amoxicillin + gentamicin

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105
Q

What should be given to pts with meningitis to reduce the risk of neurological sequelae?

A

IV dexamethasone

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106
Q

Which contacts of a meningitis pt should be treated?

A
  1. Prophylaxis to household and close contacts

2. Prophylaxis to those exposed to respiratory secretions

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107
Q

What is the abx prophylaxis for close contacts of a meningitis pt?

A
  1. Oral ciprofloxacin/rifampicin

2. If they have been in contact in 7 days before onset

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108
Q

How many types of influenza virus are there?

A

3: A, B, C

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109
Q

Which influenza virus subtypes account for the majority of clinical disease?

A

A and B

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110
Q

What are the features of the paediatric influenza vaccine?

A
  1. Given intranasally
  2. First dose at 2-3 y/o then annually after that
  3. Is a live vaccine
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111
Q

What is an allergy that is a c/i to receiving paediatric influenza vaccine?

A

Egg allergy

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112
Q

What is the valency of the adult influenza vaccine and what are its components?

A

Trivalent, with 2 subtypes of Influenza A and 1 of Influenza B

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113
Q

What kind of vaccine is the adult influenza vaccine?

A

Inactivated

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114
Q

What is a c/i to the adult influenza vaccine?

A

Hypersensitivity to egg protein

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115
Q

What is the efficacy of the adult influenza vaccine?

A

75%

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116
Q

How many days after influenza vaccination are antibodies at protective levels?

A

10-14 days

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117
Q

How should UTI in pregnancy be managed?

A

Nitrofurantoin

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118
Q

How is a UTI normally treated in non-pregnant women?

A

Trimethoprim/nitrofurantoin for 3 days

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119
Q

What does OPSI stand for?

A

Overwhelming post splenectomy infection

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120
Q

When is the risk of OPSI the greatest?

A

In the first 2 years following splenectomy

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121
Q

What infections are splenectomy pts particularly at risk of?

A
  1. Pneumococcus
  2. Meningococcus
  3. Haemophilus
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122
Q

What abx prophylaxis is given for splenectomy pts?

A

Penicillin V

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123
Q

What vaccinations should be offered to splenectomy pts?

A
  1. HiB
  2. Men A & C
  3. Annual influenza
  4. Pneumococcal every 5 years
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124
Q

What are some indications for splenectomy?

A
  1. Trauma
  2. Spontaneous rupture (EBV)
  3. Hypersplenism (hereditary spherocytosis)
  4. Malignancy (lymphoma/leukaemia)
  5. Splenic cysts/hydatid cysts/splenic abscesses
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125
Q

What are 4 complications of splenectomy?

A
  1. Haemorrhage
  2. Pancreatic fistula (due to damage to pancreatic tail)
  3. Thrombocytosis (prophylactic aspirin)
  4. Encapsulated bacteria infection
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126
Q

When should anti-retroviral therapy be started for HIV?

A

At the time of diagnosis

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127
Q

What combination of drugs does HAART usually entail?

A
  1. 2 nucleoside reverse transcriptase inhibitors (NRTIs)
    AND
  2. Protease inhibitor OR NNRTI
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128
Q

What is an entry inhibitor for HIV?

A

Maraviroc

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129
Q

What is the MOA of Maraviroc?

A

Binds to CCR5, preventing interaction with gp41

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130
Q

What is enfuvirtide?

A

A fusion inhibitor, binds to gp41

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131
Q

What are some examples of NRTIs (nucleoside analogue reverse transcriptase inhibitors)?

A
  1. Zidovudine
  2. Abacavir
  3. Emtricitabine
  4. Lamivudine
  5. Stavudine
  6. Tenofovir
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132
Q

What is a general side effect of NRTIs?

A

Peripheral neuropathy

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133
Q

What are 2 s/es of tenofovir?

A

Renal impairment and osteoporosis

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134
Q

What are 3 s/e of zidovudine

A
  1. Anaemia
  2. Myopathy
  3. Black nails
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135
Q

What are 2 examples of NNRTIs?

A
  1. Nevirapine

2. Efavirenz

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136
Q

What are some protease inhibitors?

A
  1. Ritonavir

2. Indinavir

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137
Q

What is a s/e of ritonavir?

A

P450 inhibitor

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138
Q

What is an example of an integrase inhibitor?

A

Raltegravir

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139
Q

What is the most appropriate diagnostic test for mycoplasma?

A
  1. Serology

2. Cold agglutination test

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140
Q

What are 2 characteristic complications of Mycoplasma pneumoniae?

A
  1. Erythema multiforme

2. Cold AIHA

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141
Q

What are atypical lymphocytes suggestive of?

A

Glandular fever

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142
Q

What are 3 causes of glandular fever?

A
  1. EBV (90%)
  2. CMV
  3. HHV6
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143
Q

What is the classic triad of infectious mononucleosis?

A
  1. Sore throat
  2. Pyrexia
  3. Lymphadenopathy
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144
Q

What percentage of pts with infectious mononucleosis have splenomegaly?

A

50%

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145
Q

What develops in 99% of pts with infectious mononucleosis if they take ampicillin/amoxicillin?

A

A maculopapular, pruritic rash

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146
Q

How is infectious mononucleosis diagnosed?

A

Heterophile antibody test (Monospot test)

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147
Q

What is the management of infectious mononucleosis?

A
  1. Rest, fluid, avoid alcohol
  2. Simple analgesia for aches or pains
  3. Avoid contact sports for 8 weeks
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148
Q

Which 2 vaccinations are routinely offered to pregnant women in the UK?

A

Influenze and pertussis

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149
Q

What is the abx of choice for UTIs post-partum?

A

Trimethoprim (is present in milk but not harmful)

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150
Q

What is the MOA of trimethoprim?

A

Dihydrofolate reductase inhibitor

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151
Q

What are 2 s/e of trimethoprim?

A
  1. Myelosuppression
  2. Transient rise in creatinine
  3. Hyperkalaemia
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152
Q

Why does trimethoprim cause a transient rise in creatinine?

A

It competitively inhibits the tubular secretion of creatinine resulting in a temporary increase (blocks ENaC channel in the distal nephron), also leading to hyperkalaemia

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153
Q

What status is very important in the management of bites?

A

Tetanus status

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154
Q

To whom should IM human tetanus Ig be given to in A&E?

A

High risk wounds e.g. compound fractures, significant degree of devitalised tissue

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155
Q

What is the dosage for Abx prophylaxis in splenectomy pts?

A
  1. Penicillin V 500mg BD

2. Amoxicillin 250mg BD

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156
Q

A pt goes somewhere sunny and develops a cold sore, why?

A

Sunlight is a common trigger for cold sores

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157
Q

How can you classify the causes of diarrhoea in HIV?

A
  1. HIV enteritis

2. Opportunistic infection

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158
Q

What are some opportunistic infections that can cause diarrhoea in HIV?

A
  1. Cryptosporidium and other protozoa (most common)
  2. CMV
  3. MAI
  4. Giardia
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159
Q

What is the most common infective cause of diarrhoea in HIV pts?

A

Cryptosporidium

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160
Q

When is MAI infection typically seen in HIV?

A

When CD4 count is <50

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161
Q

How is MAI managed?

A
  1. Rifabutin
  2. Ethambutol
  3. Clarithromycin
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162
Q

What is a good initial IV bolus to give for HIV?

A

500ml over 15min

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163
Q

For every hour that IV Abx are delayed for sepsis, what is the percentage increase in mortality?

A

8%

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164
Q

How can you define traveller’s diarrhoea?

A

3 loose to watery stools in 24 hours

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165
Q

What is the most common cause of traveller’s diarrhoea?

A

E coli

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166
Q

What are 3 causes of acute food poisoning?

A
  1. B. cereus
  2. S. aureus
  3. C. perfringens
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167
Q

What is the typical hx for giardiasis?

A
  1. Prolonged, non-bloody diarrhoea

2. Chronic diarrhoea, malabsorption and lactose intolerance can occur

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168
Q

What is the typical hx for shigella?

A

Bloody diarrhoea, vomiting and abdo pain

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169
Q

What is the typical hx for campylobacter?

A

Flu-like prodrome usually followed by crampy abdo pain, fever, and diarrhoea (can be bloody)

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170
Q

What condition may a campylobacter infection mimic?

A

Appendicitis

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171
Q

What is a complication of campylobacter infection?

A

Guillain-Barre syndrome

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172
Q

What is the typical history for amoebiasis?

A

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

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173
Q

Reheated rice and diarrhoea cause?

A

Bacillus cereus

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174
Q

What is the MOA by which B. cereus causes diarrhoea in reheated rice?

A

Their spores germinate in cooked rice and produce toxin if the cooked product is kept insufficiently chilled

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175
Q

What is the the standard therapy for TB?

A
  1. RIPE 2 months

2. RI 4 months

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176
Q

What is the treatment for latent TB?

A
  1. RI for 3 months OR

2. I for 6 months

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177
Q

When may directly observed therapy be used for TB treatment?

A

3x a week dosing regimen

  1. Homeless with active TB
  2. Pts with poor compliance
  3. All prisoners
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178
Q

How does dengue usually present?

A

Fever and joint pains

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179
Q

How does leptospirosis usually present?

A
  1. Biphasic pattern of fever and headaches

2. Continuing muscle and abdo pain

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180
Q

What causes typhoid?

A

Salmonella typhi

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181
Q

What causes paratyphoid?

A

Salmonella paratyphi

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182
Q

How is typhoid transmitted?

A

Faeco-oral route

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183
Q

What are some distinguishing features of typhoid infection?

A
  1. Relative bradycardia
  2. Constipation
  3. Rose spots (40% pts, more common in paratyphoid)
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184
Q

When should re-infection with syphilis be suspected?

A

If the RPR test rises by 4-fold or more

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185
Q

What is the RPR test?

A

Rapid plasma reagin test

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186
Q

What does the Enzyme Immunoassay Test (EIA) for syphilis measure?

A

Acute IgM Ab to syphilis, may be negative in reinfection

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187
Q

What is the TPPA test?

A

T. Pallidum particle agglutination test, often remains positive in pts who have been previously infected

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188
Q

What is the 1st line treatment for syphilis?

A

IM Benpen

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189
Q

What is the management of gonorrhoea?

A

IM ceftriaxone 1g (+ oral azithromycin, depending on guideline)

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190
Q

How can you classify serological tests for syphilis?

A
  1. Cardiolipin test = VDRL, RPR

2. Treponemal specific Ab tests = TPHA

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191
Q

How long does HIV seroconversion take?

A

3-12 weeks

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192
Q

What is seroconversion?

A

The period where an antibody response is created and is detectable

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193
Q

If pts take an ELISA test and are HIV negative, when are they recommended to retake the test to confirm they are HIV free?

A

After 3 months

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194
Q

In what percentage of pts is HIV seroconversion symptomatic?

A

60-80%

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195
Q

What are the typical symptoms of HIV seroconversion?

A
  1. Sore throat
  2. Lymphadenopathy
  3. Malaise, myalgia, arthralgia
  4. Diarrhoea
  5. Maculopapular rash
  6. Mouth ulcers
  7. Rarely meningoencephalitis
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196
Q

What bacterium is the cause of immune-mediated neurological disease after a pneumonia?

A

Mycoplasma pneumoniae

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197
Q

What are 5 live attenuated vaccines?

A
  1. BCG
  2. MMR
  3. Oral polio
  4. Oral typhoid
  5. Yellow fever
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198
Q

What are three toxoid (inactivated toxin) vaccines?

A
  1. Tetanus
  2. Diphtheria
  3. Pertussis
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199
Q

Abx tx for exacerbation of chronic bronchitis?

A

Amoxicillin or clarithromcyin

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200
Q

Abx tx for uncomplicated CAP?

A

Amoxicillin

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201
Q

Abx tx for atypical pneumonia?

A

Clarithromycin

202
Q

Abx tx for for HAP?

A
  1. W/in 5 days of admission = co-amoxiclav or cefuroxime

2. >5d after admission = Piptaz OR Cipro OR Ceftazidime

203
Q

Abx tx for acute prostatitis?

A

Quinolone or tripmethoprim

204
Q

Abx tx for for cellulitis?

A

Flucloxacillin

205
Q

Abx tx for for cellulitis near eye or nose?

A

Co-amoxiclav

206
Q

Abx tx for erysipelas?

A

Flucloxacillin

207
Q

Abx tx for animal/human bite?

A

Co-amoxiclav

208
Q

Abx tx for mastitis during breast feeding?

A

Flucloxacillin

209
Q

Abx tx for throat infections?

A

Phenoxymethylpenicillin

210
Q

Abx tx for sinusitis?

A

Amoxicillin

211
Q

Abx tx for otitis media?

A

Amoxicillin

212
Q

Abx tx for otitis externa?

A

Flucloxacillin

213
Q

Abx tx for periodontal/periapical abscess?

A

Amoxicillin

214
Q

Abx tx for acute necrotising ulcerative gingivitis?

A

Metronidazole

215
Q

Abx tx for chlamydia?

A

Doxycycline

216
Q

Abx tx for PID?

A

IM ceftriaxone + oral doxycycline + oral metronidazole

217
Q

Abx tx for syphilis?

218
Q

Abx tx for C.diff?

A
  1. First episode = metronidazole

2. Second/subsequent episode = vancomycin

219
Q

Abx tx for campylobacter enteritis?

A

Clarithromycin

220
Q

Abx tx for for salmonella (non-typhoid)?

A

Ciprofloxacin

221
Q

Abx tx for shigellosis?

A

Ciprofloxacin

222
Q

How many tetanus doses confers lifelong protection?

223
Q

What are genital warts also known as?

A

Condylomata accuminata

224
Q

What are the main HPV subtypes that cause genital warts?

A

HPV 6 & 11

225
Q

What do genital warts look like?

A

Small, 2-5mm fleshy protuberances which are slightly pigmented that may bleed or itch

226
Q

What is the management of genital warts?

A
  1. Multiple non-kersatinised warts = topical podophyllum
  2. Solitary, keratinised warts = cryotherapy
  3. Second line = topical imiquimod
227
Q

What are pearly penile papules?

A

A normal variant of the glans, do not require intervention, and are not caused by any form of virus

228
Q

What causes LGV?

A

Chlamydia trachomatis

229
Q

What are the 3 stages of lymphogranuloma venereum?

A
  1. Small painless pustule which later forms an ulcer
  2. Painful inguinal lymphadenopathy
  3. Proctocolitis
230
Q

How is LGV treated?

A

Doxycycline

231
Q

What are some causes of genital ulcers?

A
  1. Infective = genital herpes, syphilis, chancroid, LGV, granuloma inguinal
  2. Inflammation = Behcet’s disease
  3. Malignancy
232
Q

What causes granuloma inguinale?

A

Klebsiella granulomatis

233
Q

What virus causes Kaposi’s sarcoma?

234
Q

How does Kaposi’s sarcoma present?

A

Purple papules or plaque on the skin or mucosa

235
Q

What are the respiratory complications of Kaposi’s sarcoma|?

A

Haemoptysis and pleural effusion

236
Q

What is the management of Kaposi’s sarcoma?

A

Radiotherapy and resection

237
Q

Is rifampicin a potent liver enzyme inhibitor or inducer?

238
Q

What blood findings are typical of dengue?

A

Low platelet count and raised transaminases

239
Q

How does dengue typically present?

A
  1. Retro-orbital headache
  2. Fever
  3. Myalgia
  4. Pleuritic pain
  5. Facial fluhing
  6. Maculopapular rash
240
Q

What is the treatment of dengue?

A

Entirely symptomatic (fluid resus, blood transfusion etc.), no antiviral are currently available

241
Q

What transmits dengue?

A

Aedes aegypti mosquito

242
Q

What is the incubation for dengue?

243
Q

What is the mainly complicatoin of dengue?

A

A form of disseminated intravascular coagulation (DIC) known as dengue haemorrhagic fever (DHF) may develop. Around 20-30% of these patients go on to develop dengue shock syndrome (DSS)

244
Q

What are the EBV-associated malignancies?

A
  1. Burkitt’s lymphoma
  2. Hodgkin’s lymphoma
  3. HIV-associated CNS lymphomas
  4. Nasopharyngeal carcinoma
245
Q

How can you treat pts with cellulitis who are penicillin allergic?

A

Clarithromycin or clindamycin

246
Q

What classification system can be used to guide treatment of cellulitis?

A

Eron classification

247
Q

Which Eron classification classes suggests pts should be given IV Abx?

A

Class III or IV

248
Q

What causes Lyme disease?

A

Borrelia burgdorferi

249
Q

What transmits Borrelia?

A

The Ixodes tick

250
Q

How can you classify the features of Lyme disease?

A
  1. Early = ECM in 80%, fever, arthralgia
  2. Cardiovascular = heart block, myocarditis
  3. Neurological = facial nerve palsy, meningitis
251
Q

How is lyme diagnosed?

A

ELISA –> if positive, then an immunoblot test for Lyme disease should be done

252
Q

What is the management of Lyme disease?

A

14-21 day course of oral Doxycycline

253
Q

What is sometimes seen after initiating Lyme management??

A

The Jarisch-Herxheimer reaction

254
Q

What is the Jarisch-Herxheimer reaction?

A

A reaction to endotoxin-like products released by the death of harmful microorganisms within the body during antibiotic treatmen

255
Q

After treatment of what disease is the Jarisch-Herxheimer reaction typically seen?

256
Q

What are some symptoms of the Jarisch-Herxheimer reaction?

A

After the first dose of antibiotic:

  1. Fever
  2. Rash
  3. Tachycardia
257
Q

What is N. meningitidis?

A

A gram negative diplococcus

258
Q

What is S. pneumoniae?

A

A gram positive diplococcus/chains

259
Q

What is E.coli?

A

A gram negative baciilli

260
Q

What is H. influenzae?

A

A gram negative coccobacilli

261
Q

What is L. monocytogenes?

A

A gram positive rod

262
Q

What is the management for women who present with a primary herpes infection in their third trimester of pregnancy?

A
  1. Oral ACV 400mg TDS until delivery

2. Elective CS

263
Q

What is a typical finding on CXR of legionella infection?

A

Pleural effusion

264
Q

What is malorone?

A

Atovaquone and proguanil

265
Q

What are some malaria treatments?

A
  1. Malorone
  2. Chloroquine
  3. Doxycycline
  4. Mefloquine (Lariam)
  5. Proguanil
  6. Proguanil + Chloroquine
266
Q

What antimalarial is taken once weekly?

A

Mefloquine (Lariam)

267
Q

What antimalarial should be avoided if the pt has a history of depression?

A

Mefloquine (Lariam)

268
Q

What is the main s/e of malorone?

269
Q

Bilateral conjunctivitis, bilateral calf pains and high fevers in a sewage worker>

A

Leptospirosis

270
Q

What are some features of fulminant leptospirosis (Weil’s disease)?

A
  1. Hepatitis –> jaundice
  2. Pulmonary haemorrhage
  3. AKI
271
Q

What are some features of mild/anicteric leptospirosis?

A
  1. Bilateral conjunctivitis
  2. Bilateral calf pain
  3. high fever
272
Q

How is leptospirosis transmitted?

A

Contact of broken skin with urine of infected rodents

273
Q

What percentage of pts with mild/anicteric lepto go on to develop fulminant lepto (Weil’s disease)?

274
Q

What is the management of leptospirosis?

A

High dose benzylpenicillin or doxycycline

275
Q

What causes leptospirosis?

A

Leptospira interrogans

276
Q

What is hairy leukoplakia?

A

An EBV-associated lesion on the side of the tongue that is considered indicative of HIV

277
Q

What is the incubation period of yellow fever?

278
Q

How is yellow fever spread?

A

Aedes mosquito

279
Q

What are some features of yellow fever?

A
  1. May cause mild flu-like illness lasting less than one week
  2. Initial high fevers, rigors, N&V
  3. A brief remission followed by jaundice, haematemesis, and oliguria
280
Q

What may seen in the hepatocytes in yellow fever?

A

Councilman bodies (inclusion bodies)

281
Q

What is the commonest cause of viral encephalitis?

282
Q

What viruses does the enterovirus family contain?

A
  1. Coxsackie
  2. Echovirus
  3. Rhinovirus
283
Q

What are enteroviruses?

A

Positive-sense ssRNA virus

284
Q

What is the most common cause of bronchiolitis?

285
Q

What is the most common cause of croup?

A

Parainfluenza virus

286
Q

What is the most common cause of the common cold?

A

Rhinovirus

287
Q

What is the most common cause of bronchiectasis exacerbations?

A

H. influenzae

288
Q

What is the most common cause of pyelonephritis?

289
Q

What causes tetanus?

A

Release of tetanospasmin exotoxin from Clostridium tetani

290
Q

What is the MOA of tetanospasmin?

A

Prevents release of GABA

291
Q

What are some features of tetanus?

A
  1. Prodrome fever, lethargy, headache
  2. Trismus (lockjaw)
  3. Risus sardonicus
  4. Opisthotonus (arched back, hyperextended neck)
  5. Spasms (dysphagia)
292
Q

What is the management of tetanus?

A
  1. Supportive incl. ventilatory support and muscle relaxants
  2. IM human tetanus Ig for high risk wounds
  3. Metronidazole (now preferred to benpen)
293
Q

What are some risk factors for invasive aspergillosis?

A
  1. HIV
  2. Leukaemia
  3. Following broad spectrum Abx
294
Q

What are 3 species of Aspergillus?

A
  1. Fumigatus
  2. Flavus
  3. Terreus
295
Q

What is an aspergilloma?

A

A mycetoma (mass-like fungus ball) which often colonises an existing lung cavity (e.g. secondary to TB, lung cancer, CF)

296
Q

What is the triad of Behcets disease?

A
  1. Oral ulcers
  2. Genital ulcers
  3. Anterior uveitis
  4. VTE is also seen
297
Q

Where can gonorrhoea present?

A

Any mucous membrane surface, typically GU but also the rectum and pharynx

298
Q

What are some features of gonorrhoea?

A
  1. Males = urethral discahrge, dysuria
  2. Females = cervicitis –> vaginal discharge
  3. Rectal and pharyngeal infection usually asymptomatic
299
Q

What are some complications of gonorrhoea?

A
  1. Local = urethral strictures, epididymitis, salpingitis

2. Systemic = Disseminated gonococcal infection (DGI) and gonococcal arthritis

300
Q

What is the classic triad of sx of disseminated gonococcal infection (DGI)?

A
  1. Tenosynovitis
  2. Migratory polyarthritis
  3. Dermatitis
301
Q

What is the rabies virus?

A

An RNA rhabdovirus

302
Q

How does rabies travel to the CNS?

A

Following a bite, the virus travels up the nerve axons towards the CNS in a retrograde fshion

303
Q

What are some features of rabies?

A
  1. Prodrome = headache, fever, agitation
  2. Hydrophobia = water-provoking muscle spasms
  3. Hypersalivation
304
Q

What do you see in neurones infected by rabies?

A

Negri bodies (cytoplasmic inclusion bodies)

305
Q

What is the management of an animal bite in a country at-risk of rabies?

A
  1. Wash the wound
  2. If already immunised, then 2 further doses of vaccine should be given
  3. If not immunised, HRIG (human rabies Ig) and a full course of vaccination should be given
306
Q

What infection does strep pyogenes rarely cause?

307
Q

What does BCG stand for?

A

Bacille Calmette-guerin

308
Q

What does the BCG vaccine contain?

A

Live attenuated Mycobacterium bovis

309
Q

What does the BCG vaccine also offer limited protection against?

310
Q

What are some contraindications to the BCG vaccine?

A
  1. Previous BCG vaccinations
  2. Past hx of TB
  3. HIV
  4. Pregnancy
  5. Positive tuberculin test
311
Q

Over what age group is the BCG vaccine not given due to no evidence to suggest it works?

312
Q

Do children >6y/o require a tuberculin skin test prior to receiving the BCG vaccine?

313
Q

What does JC virus cause in an immunocompromised pt?

A

Progressive multifocal leukoencephalopathy

314
Q

How can you classify HIV opportunistic infection?

A

Based on CD4 count

  1. 200 - 500 cells/mm3
  2. 100 - 200 cells/mm3
  3. 50 - 100 cells/mm3
  4. 0 - 50 cells/mm3
315
Q

What are some 200 - 500 cells/mm3 HIV infections?

A
  1. Oral thrush (C. albicans)
  2. Shingles (HZV)
  3. Hairy leukoplakia (EBV)
  4. Kaposi’s sarcoma (HHV8)
316
Q

What are some 100 - 200 cells/mm3 HIV infections?

A
  1. Cryptosporidiosis
  2. Cerebral toxoplasmosis
  3. PML (JCV)
  4. PCP
  5. HIV dementia
317
Q

What are some 50 - 100 cells/mm3 HIV infections?

A
  1. Aspergillosis
  2. Oesophageal candidiasis
  3. Cryptococcal meningitis
  4. Primary CNS lymphoma (EBV)
318
Q

What are some 0 - 50 cells/mm3 HIV infections?

A
  1. CMV retinitis (30-40%)

2. MAI infection

319
Q

What is black hairy tongue?

A

A temporary, harmless oral condition which results from defective desquamation of the piliform papillae. Despite the name, the tongue can be brown, green, pink, or another colour

320
Q

What are some predisposing factors for black hairy tongue?

A
  1. Poor oral hygiene
  2. Smoking
  3. IVDU
  4. Abx (paritcularly tetracyclines)
321
Q

What are some s/e of tetracyclines?

A
  1. Discoloration of teeth (so shouldnt be used in children <12y/o)
  2. Photosensitivity
  3. Angiodema
  4. Black hairy tongue
322
Q

What are some indications of tetracyclines?

A
  1. Acne
  2. Lyme disease
  3. Chlamydia
  4. Mycoplasma
323
Q

Which of the hepatitides is most commonly spread by undercooked pork?

324
Q

What kind of vaccine is influenza?

A

Inactivated

325
Q

What are 3 conjugate vaccines?

A
  1. Pneumococcus
  2. Haemophilus
  3. Meningococcus
326
Q

What abx class causes photosensitivity?

A

Tetracyclines

327
Q

Are X-ray changes in Pneumocystis jiroveci pneumonia generally too subtle for non-radiologists to detect

328
Q

What is an SBA finding of PCP?

A

Exercise-induced desaturation

329
Q

How may Kaposi’s sarcoma present in children?

A

Only generalised lymphadenopathy, suggestive of lymphoma

330
Q

What causes the blue-green colour with Pseudomonas infections?

A

The pigment pyocyanin

331
Q

What is pseudomonas aeruginosa?

A

A gram negative rod

332
Q

How does pseudomonas exert its deleterious effects?

A

Produces both an endotoxin and exotoxin

333
Q

What is the likely causative organism of a chest infection in CF?

A

Pseudomonas aeruginosa

334
Q

How can you differentiate anaphylaxis from a Jarisch-Herxheimer reaction?

A

There is no wheeze or hypotension in the JHR

335
Q

What is the management of a Jarisch-Herxheimer reaction?

A

No treatment other than antipyretics PRN

336
Q

When should vaccines be given before an elective splenectomy?

A

Two weeks before surgery

337
Q

What is the incubation period of Hep A?

338
Q

What kind of virus is Hep A?

A

RNA picornavirus

339
Q

What are the features of Hep A?

A
  1. Flu-like prodrome

2. Jaundice, hepatosplenomegaly

340
Q

What are the complications of Hep A?

A

Complications are very rare and there is no increased risk of HCC

341
Q

How would you treat 12 weeks pregnant lady with syphilis?

A

IM benzathine penicillin G

342
Q

What are some occupations that get leptospirosis?

A
  1. Sewage workers
  2. Farmers
  3. Vets
  4. Abattoir workers
343
Q

What do you give for an animal or human bite in the UK?

A

Co-amoxiclav

344
Q

What is the most commonly isolated organism from an animal bite?

A

Pasteurella multocida

345
Q

What is the most common neurological infection seen in HIV?

A

Cerebral toxoplasmosis (10%)

346
Q

Pt with HIV, neuro symptoms, multiple brain lesions with ring enhancement?

A

Cerebral toxoplasmosis

347
Q

What is the management for cerebral toxoplasmosis?

A

Sulfadiazine and pyrimethamine

348
Q

What neuro malignancy is associated with an EBV infection in HIV?

A

Primary CNS lymphoma

349
Q

How can you differentiate between primary CNS lymphoma and cerebral toxoplasmosis in an HIV pt?

A
  1. Toxoplasmosis = multiple lesions, ring or nodular enhancement, thallium SPECT negative
  2. Lymphoma = single lesion, solid homogeneous enhancement, thallium SPECT positive
350
Q

What is the most common fungal infection of the CNS in HIV?

A

Cryptococcus

351
Q

What do you see on CSF in cryptococcus?

A

High opening pressure, India Ink test positive

352
Q

What is the pathophysiology of PML?

A

Widespread demyelination due to infection of oligodendrocytes by JCV (a polyoma DNA virus)

353
Q

What do you see on CT of AIDS dementia complex?

A

Cortical and subcortical atrophy

354
Q

What is the main technique used for screening of latent TB?

A

The Mantoux test

355
Q

What produces a false positive of the Mantoux test?

A
  1. Miliary TB
  2. Sarcoidosis
  3. HIV
  4. Lymphoma
  5. Very young age (<6m)
356
Q

Has the Heaf test been discontinued?

357
Q

How is the Mantoux test performed?

A

0.1ml of 1:1000 purified protein derivative (PPD) injected intradermally, and the result is read 2-3 days later

358
Q

How is the the mantoux test interpreted?

A
  1. <6mm = negative = previously unvaccinated individuals may be given BCG
  2. 6-15mm = positive = should not be given BCG, may be due to previous TB infection or BCG
  3. > 15mm = strongly positive = suggests TB infection
359
Q

What cell count is diagnostic of a UTI?

A

Pure growth >10^5 organisms/mL on a MSU

360
Q

What kind of virus is Hep C?

A

RNA flavivirus

361
Q

What is the incubation period of Hep C?

362
Q

What is the risk of transmission of Hep C during a needlestick?

363
Q

What is the risk of transmission of Hep C from mother to child?

364
Q

How is chronic Hep C defined?

A

Persistence of HCV RNA in the blood for 6 months

365
Q

What are some complications of Hep C?

A
  1. Rheum = arthralgia, arthritis
  2. Eyes = Sjogrens
  3. Liver = cirrhosis, HCC
  4. Cryoglobulinaemia - typically Type II
  5. PCT
  6. Membranoproliferative GN
366
Q

What is the management of chronic Hep C?

A
  1. Depends on viral genotype

2. Protease inhibitor with or without ribavarin

367
Q

What is the goal of Hep C treatment?

A

A sustained virologic response (SVR)

368
Q

How is Sustained virologic response (SVR) defined?

A

Undetectable serum HCV RNA 6m after the end of therapy

369
Q

What are 2 s/e of ribavarin?

A
  1. Haemolytic anaemia

2. Cough

370
Q

What is the single most effective step at reducing the incidence of MRSA?

A

Hand hygeine

371
Q

Which pts should be screened for MRSA?

A

All pts awaiting elective admissions

372
Q

How is MRSA suppressed from a carrier one identified?

A
  1. Nose = mupirocin 2% in white soft paraffin, TDS for 5 days
  2. Skin = chlorhexidine gluconate, OD for 5 days (apply all over but particularly to the axilla, groin and perineum)
373
Q

What are 3 drugs commonly used in the treatment of MRSA infections?

A
  1. Vancomycin
  2. Linezolid
  3. Teicoplanin
374
Q

At what CD4 level does PCP usually occur?

A

<200 cells/mm3

375
Q

What organisms are visualised by India-Ink staining?

A

Cryptococcus

376
Q

How can HIV be diagnosed?

A
  1. HIV Ab test = most common and accurate, consists of both a screening ELISA and confirmatory Western blot
  2. p24 antigen test = sometimes used as an additional screening test in blood banks
377
Q

When is the HIV antibody test positive?

A

Most people develop Abs to HIV at 4-6 weeks byt 99% do by 3 months

378
Q

When is the HIV p24 antigen test positive?

A

From about 1 week to 3-4 weeks after infection with HIV

379
Q

Following treatment for syphilis, what happens to TPHA and VDRL?

A
  1. TPHA remains positive

2. VDRL becomes negative

380
Q

What is TPHA?

A

Treponema Pallidum Haemagglutination Assay

381
Q

What are high risk areas for Lyme disease in the UK?

A

South of England and the Scottish Highlands

382
Q

Is the presence of erythema migrans sufficient to begin treating a pt for Lyme disease?

383
Q

What is determined to be severe falciparum malaria?

A

High parasitaemia (>2%) and various other derangements

384
Q

What is the 1st line management for severe falciparum malaria?

A

IV artesunate

385
Q

What is the management of non-severe falciparum malaria?

A

Oral artesunate combination therapy (ACT)

386
Q

What are some complications of falciparum malaria?

A
  1. Cerebral malaria = seizures, coma
  2. AKI = blackwater fever secondary to intravascular haemolysis
  3. ARDS
  4. DIC
  5. Hypoglycaemia
387
Q

What is an example of an artesunate combination therapy?

A

Artemether + lumefantrine

388
Q

What is recommended if falciparum parasite count is >10%?

A

Exchange transufusion

389
Q

What might shock in malaria indicate?

A

Coexistent bacterial septicaemia (as malaria rarely causes haemodynamic collapse)

390
Q

Is there a risk of HCC with Hep A?

391
Q

What is the most likely cause of a persistent PUO and lymphadenopathy with high WCC?

392
Q

What is the commonest type of malaria?

A

Falciparum

393
Q

How can E coli be classified?

A

According to antigens which may trigger an immune response: O, K, H

394
Q

What imaging is required to diagnose a suspected spinal epidural abscess?

A

Full spine MRI to search for skip lesions

395
Q

What is an abscess?

A

A collection of pus encapsulated by a pyogenic membrane

396
Q

What is a spinal epidural abscess (SEA)?

A

A collection of pus that is superficial to the dura mater

397
Q

How does an spinal epidural abscess arise?

A
  1. Contiguous from adjacent structures e.g. discitis
  2. Haematogenous e..g bacteraemia from IVDU
  3. Direct e.g. surgeyr
398
Q

What is the most common causative organism of a spinal epidural abscess?

399
Q

What is the triad of presentation of a spinal epidural abscess?

A
  1. Fever
  2. Back pain
  3. Focal neurological deficits according to the segment of the cord affected
400
Q

What is PEP for HIV?

A

Oral antiretroviral therapy for 4 weeks ASAP after exposure

401
Q

How much does PEP for HIV reduce risk of transmission?

402
Q

What causes amoebiasis?

A

Entamoeba histolyca

403
Q

How is amoeba spread?

A

Faeco-oral

404
Q

What percentage of the world is chronically infected with entamoeba?

405
Q

When abscess does amoeba cause?

A

Liver and colonic

406
Q

What are 3 presentations of amoeba?

A
  1. Asymptomatic
  2. Mild diarrhoea
  3. Amoebic dystentery
  4. Amoebic liver abscess
407
Q

How does amoebic dysentery present?

A
  1. Profuse, bloody diarrhoea
  2. Long incubation period
  3. Hot stool may show trophozoites
408
Q

How is amoebic dysentery treated?

A

Metronidazole

409
Q

How are the contents of an amoebic liver abscess described?

A

Anchovy sauce

410
Q

What are some features of an amoebic liver abscess?

A
  1. Fever and RUQ

2. Serology is positive in 90%

411
Q

How is an amoebic liver abscess treated?

A
  1. Luminal amoebicide to eradicate the cystic stage which is resistant to metronidazole and tinidazole
  2. Metronidazole
412
Q

What is the incubation period of Ebola virus?

413
Q

What virus family is ebola part of?

A

Filoviridae

414
Q

What is the average fatality of ebola in pervious outbreaks?

415
Q

How does ebola spread?

A

Human to human spread via direct contact through broken skin or mucous membranes (including contaminated bedding, clothing and surfaces)

416
Q

When do ebola pts become infectious?

A

When they develop symptoms

417
Q

What abx should be added in the treatment of pneumonia if secondary to influenza?

A

Flucloxacillin

418
Q

What is the most common complication of gonorrhoea?

A

Subfertility secondary to PID

419
Q

When can babies born to mothers with known HIV be described as seronegative?

A

If they are negative at birth, 3m, 6m, and at 18m

420
Q

When should HIV in asymptomatic patients be done?

A

4 weeks after possible exposure

421
Q

What are 3 metabolic abnormalities caused by cholera?

A
  1. Hypokalaemia
  2. Hypoglycaemia
  3. Metabolic acidosis
422
Q

What is the management of cholera?

A
  1. Oral rehydration therapy

2. Abx = doxycycline, ciprofloxacin

423
Q

What is vibrio cholerae?

A

A gram negative bacteria

424
Q

Man returns from kenya with maculopapular rash and flu-like illness?

A

HIV seroconversion

425
Q

What tests must be done prior to starting TB therapy?

A
  1. FBC = baseline and plt count due to hepatotoxicity
  2. LFTs = hepatotoxicity
  3. U&Es = baseline, Cr elevation
  4. Vision testing = ethambutol
426
Q

What is the most common cause of diarrhoea in pts with HIV infection?

A

Cryptosporidium

427
Q

What is co-trimoxazole?

A

Trimethoprim and Sulfamethoxazole

428
Q

Renal transplant pt with blurring of vision?

A

CMV Retinitis

429
Q

When would you see a stormy sunset appearance on fundoscopy?

A

Central retinal vein occlusion (CRVO)

430
Q

When would you see a pizza pie appearance on fundoscopy?

431
Q

What is are the features of CMV retinitis on fundoscopy?

A

Pizza-pie appearance, a mixtureof:

  1. Cotton wool spots
  2. Infiltrates
  3. Haemorrhages
432
Q

What percentage of people have been exposed to CMV?

A

50%, though only causes disease in the immunocompromise

433
Q

What are the patterns of CMV disease?

A
  1. Congenital CMV infection
  2. CMV mononucleosis
  3. CMV retinitis
  4. CMV encephalopathy
  5. CMV pneumonitis
  6. CMV colitis
434
Q

When would you see pinpoint petechial ‘blueberry muffin’ skin lesions?

A

Congenital CMV infection

435
Q

What is the treatment of choice for CMV retinitis?

A

IV ganciclovir

436
Q

A child has parvovirus B19 infection, how should you manage the pregnant mother?

A

Check maternal IgM and IgG

437
Q

What spreads Leishmaniasis?

A

Sand flies

438
Q

What are some subtypes of Leishmania?

A
  1. Tropica
  2. Mexicana
  3. Braziliensis
  4. Donovani
439
Q

What are 3 forms of leishmaniasis?

A
  1. Cutaneous
    2 Mucocutaneous
  2. Visceral (Kala-azar)
440
Q

What typically causes cutaneous leishmaniasis?

A

L tropica/mexicana

441
Q

What typically causes mucocutaneous leishmaniasis?

A

L braziliensis

442
Q

What typically causes visceral leishmaniasis?

A

L. donovani

443
Q

Return from south america with ulcerating lesions in lower lip, oral and nasal mucosa?

A

Mucocutaneous leishmaniasis

444
Q

What are some complications of mycoplasma infection?

A
  1. Cold agglutinins –> haemolytic anaemia, thrombocytopenia
  2. Erythema: multiforme, nodosum
  3. Meningoencephalitis, GBS, and other immune mediated neurological diseases
  4. Bullous myringitis = painful vesicles on the tympanic membrane
  5. Pericarditis/myocarditis
  6. GI = hepatitis, pancreatitis
  7. Renal = acute GN
445
Q

What needs to be checked before commencing a pt on terbinafine to treat a fungal nail infection?

446
Q

What are 2 animal reservoirs for toxoplasma gondii?

A

Cats and rats

447
Q

What are some features of toxoplasmosis?

A
  1. Glandular fever features
  2. Meningoencephalitis
  3. Myocarditis
448
Q

How does toxoplasma gondii enter the body?

A
  1. GI tract, lung, or broken skin

2. Oocysts release trophozoites which migrate widely around the body including to the eye, brain and muscle

449
Q

What is the most common cause of oesophagitis in pts with HIV?

A

Oesophageal candidiasis

450
Q

What are the 1st line treatments for oesophageal candidiasis?

A

Fluconazole and itroconazole

451
Q

Does an appendicectomy require prophylactic abx?

452
Q

What is a cause of Type III necrotising fasciitis?

A

Vibrio vulnificus

453
Q

What is clostridia?

A

Gram positive, obligate anaerobic bacilli

454
Q

What are some features of C. perfringens?

A
  1. Produces α-toxin, a lecithinase, which causes gas gangrene (myonecrosis) and haemolysis
  2. Tender, oedematous skin with haemorrhagic blebs and bullae. Crepitus may present on palpation
455
Q

What are some features of C. botulinum?

A
  1. Typically seen in canned foods and honey

2. Prevents ACh release, leading to flaccid paralysis

456
Q

What are some features of C. difficile?

A
  1. Causes pseudomembranous colitis, typically seen after use of BSA
  2. Produces exotoxin and cytotoxin
457
Q

What are some features of C. tetani?

A

Produces an exotoxin (tetanospasmin) that prevents the release of glycine from Renshaw cells in the spinal cord causing a spastic paralysis

458
Q

What are 4 clostridium species?

A
  1. Perfringens
  2. Botulinum
  3. Difficile
  4. Tetani
459
Q

What is the most common complication of mumps in pot-pubertal males?

460
Q

What kind of virus is mumps?

A

RNA paramyxovirus

461
Q

How is mumps spread?

A
  1. Droplets
  2. Respiratory tract epithelial cells –> parotid glands –> other tissues
  3. Incubation period 14-21 days
462
Q

What are some clinical features of mumps?

A
  1. Fever
  2. Malaise, muscular pain
  3. Parotitis (earache/pain on eating), unilateral –> bilateral
463
Q

What is the management of mumps?

A
  1. Rest

2. Paracetamol for high fever/discomfort

464
Q

What are 4 complications of mumps?

A
  1. Orchitis
  2. Pancreatitis
  3. Hearing loss (unilateral and transient)
  4. Meningoencephalitis
465
Q

How can you classify causes of gastroenteritis based upon incubation period?

A
  1. 1-6 hrs = S. aureus, B. cereus
  2. 12-48 hrs = Salmonella, E. coli
  3. 48-72 hrs = Shigella, Campylobacter
  4. > 7d = Giardiasis, Amoebiasis
466
Q

What is the relative bradycardia you see in typhoid fever called?

A

Faget’s sin

467
Q

What condition presents with ‘pea green diarrhoea’?

468
Q

After an initial negative result when testing for HV in an asymptomatic pt, when should you offer a repeat test?

A

12 weeks post expsosure

469
Q

When should HIV testing in asymptomatic patients be done after exposure?

A

4 weeks after exposure

470
Q

Why does amoebiasis lead to ‘anchovy sauce’ in the liver abscess?

A

E. histolytica digests hepatic tissue

471
Q

What is a complication of measles that can arise many years in the future?

A

Subacute sclerosing panencephalitis

472
Q

What is the classic triad of sx of glandular fever seen in 98% of pts?

A
  1. Sore throat
  2. Lymphadenopathy
  3. Pyrexia
473
Q

What are the gram positive rods?

A

ABCD L

  1. Actinomyces
  2. Bacillus anthracis
  3. Clostridium
  4. Corynebacterium diphtheriae
  5. Listeria monocytogenes
474
Q

What are the gram negative rods?

A
  1. H. influenzae
  2. E. coli
  3. P. aeruginosa
  4. Salmonella
  5. Shigella
  6. C. jejuni
475
Q

Fever on alternating days?

476
Q

How many phases does typhoid fever typically present with?

477
Q

What vaccines should be offered to pts with chronic hepatitis?

A
  1. Annual influenza

2. One-off pneumococcal

478
Q

What are 3 inactivated vaccines?

A
  1. Rabies
  2. Hep A
  3. IM influenza
479
Q

How does S. aureus cause toxic shock syndrome and gastroenteritis respectively?

A
  1. TSS = exotoxin

2. Gastroenteritis = enterotoxin

480
Q

What superantigen does S. pyogenes release that causes scarlet fever?

A

Pyogenic exotoxin A

481
Q

What is an infectious differential for RIF pain with diarrhoea?

482
Q

What is H. pylori?

A

A microaerophilic, helix-shaped, gram-negative rod

483
Q

How does H. pylori cause duodenal ulcers?

A

Colonises gastric antrum –> increased gastrin release –> high levels of gastric acid

484
Q

How does H. pylori cause gastric ulcers?

A

Diffuse H. pylory infection –> local tissue damage

485
Q

In someone who is colonised with H. pylori, what is the risk of developing a peptic ulcer?

486
Q

In someone who is colonised with H. pylori, what is the risk of developing gastric cancer?

487
Q

In someone who is colonised with H. pylori, what is the risk of developing a MALT lymphoma?

488
Q

What is the latest time that HIV PEP may be given?

A

72 hours after the event

489
Q

What is the abx management of ciprofloxacin?

A

Ciprofloxacin

490
Q

What abx can be used for traveller’s diarrhoea?

A

Clarithromycin

491
Q

What HHV is EBV?

492
Q

What may cause iron deficiency anaemia in pts returning from travel to endemic areas e.g. Indian subcontinent?

493
Q

What kind of parasite is a hookworm?

494
Q

How are hookworms acquired?

A

Skin contact with contaminated soil, commonly from walking barefoot in affected area

495
Q

How do hookworms cause IDA?

A

Skin –> intestine –> chronic blood loss

496
Q

How can hookworm be diagnosed?

A

Stool sample for ova, cysts and parasites

497
Q

What kind of vaccine is intranasal influenza?

A

Live attenuated

498
Q

What is the MOA of ritonavir?

A

Protease inhibitor

499
Q

What stain do you use to identify mycobacterium tuberculosis?

A

Ziehl-Neelsen (acid-fast)

500
Q

What is the management of primary CNS lymphoma?

A
  1. Steroids
  2. Chemotherapy e.g. methotrexate
  3. Radiation
  4. Surgery (if lower grade)
501
Q

What is Tazocin?

A

Piperacillin with Tazobactam

502
Q

What is a use of Tazocin?

A

Hospital acquired pneumonia

Medicine and Surgery Mushkies (52 decks)

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