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
2
Q
What are Amsel’s criteria for BV?
A
3/4 of:
- Thin, white homogeneous discharge
- Clue cells on microscopy
- Vaginal pH > 4.5
- Positive whiff test (KOH –> fishy odour)
3
Q
What is the management of BV?
A
Metronidazole 400mg BD for 7 days
4
Q
What are some risks of BV in pregnancy?
A
- Increased risk of preterm labour
- LBW
- Choriomamnionitis
- Late miscarriage
5
Q
What causes diphtheria?
A
Corynebacterium diphtheriae
6
Q
How does diphtheria exert its deleterious effects?
A
Release exotoxin that inhibitis protein synthesis
7
Q
How does diphtheria present?
A
- Grey diphtheric membrane on tonsils caused by necrotic mucosal cells
- Bulky cervical lymphadenopathy
- Systemic distribution –> necrosis of myocardial, neural and renal tissue
8
Q
What bacterium is responsible for the most wound infections?
A
S. aureus
9
Q
What is Truvada?
A
Emtricitabine/Tenofovir
10
Q
What should all HIV pts with CD4 < 200/mm^3 receive prophylaxis against?
A
PCP with co-trimoxazole
11
Q
What is the most common opportunistic infection in AIDS/
A
PCP
12
Q
What is pneumocystis jirovecii?
A
A unicellular eukaryote, generally classified as a fungus but some consider it a protozoa
13
Q
What is a common complication of PCP?
A
Pneumothorax
14
Q
What are 3 extrapulmonary complications of PCP?
A
- Hepatosplenomegaly
- Lymphadenopathy
- choroic lesions
15
Q
What investigation is often needed to demonstrate PCP?
A
BAL, as sputum often fails to show PCP
16
Q
What is the management of PCP?
A
- Co-trimoxazole
- IV Pentamidine in severe cases
- Aerosolized pentamidine
- Steroids if hypoxic
17
Q
What are supposedly surprisingly not notifiable diseases in the UK?
A
HIV and syphilis
18
Q
What two infections are associated with a vaginal pH > 4.5?
A
Trichomonas vaginalis and BV
19
Q
What is Trichomonas vaginalis?
A
A highly motile, flagellated protozoan
20
Q
What are some features of Trichomonas vaginalis?
A
- Frothy, offensive, yellow/green discharge
- Vulvovaginitis
- Strawberry cervix
- pH > 4.5
- In men may cause urethritis
21
Q
What is the management of trichomonas vaginalis?
A
2g Metronidazole single dose
22
Q
What is the management of necrotising fasciitis?
A
IV Abx and immediate surgical debridement
23
Q
How is necrotising fasciitis classified?
A
According to causative organism
- Mixed anaerobes and aerobes, the most common type, typically post-surgery in diabetics
- S. pyogenes
24
Q
What are some features of necrotising fasciitis?
A
- Acute onset
- Painful, erythematous lesion
- Rapidly worsening cellulitis with pain out of keeping with physical featurss
- Extremely tender over infected tissue
25
What is the cause of erythema infectiosum?
Parvovirus B19
26
What are 2 complications of parvovirus B19 infection in pregnancy?
Hydrops fetalis and death
27
What is the infectivity of parvovirus B19?
Infectious from 3 weeks before the rash, no longer infectious once the rash appears
28
What kind of virus is parvovirus B19?
DNA virus
29
What can parvovirus B19 cause in immunosuppressed pts?
Pancytopenia
30
What can parvovirus B19 cause in SCD?
Aplastic crises (Parvo B19 suppresses erythropoiesis for about a week)
31
What is the main s/e of ethambutol, and as such what should be checked?
1. Optic neuritis
| 2. Visual acuity should be checked before and after treatment
32
What are 3 s/e of isoniazid?
1. Peripheral neuropathy
2. Hepatitis
3. Agranulocytosis
33
What are 4 s/e of pyrazinamide?
1. Myalgia
2. Arthralgia
3. Hepatitis
4. Hyperuricaemia (gout)
34
What are some s/e of rifampicin?
1. Orange secretions
2. Hepatitis
3. Flu-like sx
4. Potent CYP450 enzyme inducer
35
What must one consider in deterioration of a pt with Hep B?
HCC
36
What should surveillance of pts with diagnosed cirrhoses entail?
6m intervals:
1. Abdominal US
2. Measuring AFP levels
37
What is fulminant hepatitis?
A rare syndrome of massive necrosis of the liver parenchyma
38
What may cause fulminant hepatitis in a pt with Hep B?
Hep D co-infection
39
What kind of DNA is Hep B?
dsDNA hepadnavirus
40
What is incubation period of Hep B?
6-20 weeks
41
What are some complications of Hep B?
1. Chronic hepatitis
2. Fulminant liver failure
3. HCC
4. GN
5. PAN
6. Cryoglobulinaemia
42
What does an anti-HBs level >100 indicate?
Adequate response, no further testing required, receive booster at 5 years
43
What does an anti-HBs level 10-100 indicate?
Suboptimal response, one additional vaccine dose should be given, if immunocompetent then no further testing required
44
What does an anti-HBs level <10 indicated?
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
45
What are some management options for Hep B?
Pegylated IFN-a, tenofovir, entecavir, telbivudine
46
What happens if a pt takes metronidazole and ethanol?
A disulfiram-like reaction
1. Head and neck flushing
2. N&V
3. Sweatiness
4. Headaches
5. Palpitations
47
What is the most common infection found in central line infections?
Staphylococcus epidermidis
48
Is S. aureus coagulase negative or positive?
Positive
49
Is S. epidermidis coagulase positive or negative?
Negative
50
What are two salient infections caused by S. epidermidis?
1. Central line infections
| 2. Infective endocarditis
51
What are the components of the qSOFA score?
1. RR > 22/min
2. Altered mentation
3. SBP < 100mmHg
52
When is a qSOFA score used?
Risk of morbidity and mortality in pts with sepsis not in IVCU
53
What is the sepsis 6?
1. 3 in = oxygen, BS ABx, IV fluid (500ml crystalloid over less than 15 mins)
2. 3 out = cultures, lactate, hourly urine output
54
What causes chancroid?
Haemophilus ducreyi
55
What causes syphilis?
Treponema pallidum
56
What causes lymphogranuloma venereum?
Chlamydia trachomatis
57
What causes granuloma inguinale?
Klebsiella granulomatis
58
What are some features of chancroid?
1. Painful genital ulcers (sharply defined, ragged, undermined border)
2. Unilateral, painful lymph node enlargement
59
How can you classify the features of syphilis?
Primary, secondary and tertiary stages
60
What are some primary features of syphilis?
1. Chancre
| 2. Local non-tender lymphadenopathy
61
What are some secondary features of syphilis?
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)
62
What are some tertiary features of syphilis?
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
63
What is the incubation period of syphilis?
Between 9-90 days
64
What is used for treatment of thrush?
Fluconazole
65
What do HSV1 and HSV2 typically cause?
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!
66
What are some features of HSV?
1. Primary infection may present with a severe gingivostomatitis
2. Cold sores
3. Painful genital ulceration
67
What is the management of gingivostomatitis secondary to HSV?
Oral aciclovir and chlorhexidine mouthwash
68
What is the management of cold sores?
Topical Aciclovir
69
What is the management of genital herpes?
Oral aciclovir
70
What are the signs of infection by HSV on microscopy of a pap smear?
3Ms
1. Multinucleation
2. Margination of the chromatin
3. Moulding of the nuclei
71
What bacteria commonly causes reactivation of HSV, resulting in cold sores?
Streptococcus pneumoniae
72
What is the most common cause of CAP?
S. pneumoniae
73
What commonly causes CAP after the flu?
S. aureus
74
What is a classical cause of pneumonia in alcoholics?
Klebsiella pneumoniae
75
What is the formal term for a cold sore?
Herpes labialis
76
What causes giardiasis?
Giardia lamblia
77
What is Giardia lamblia?
A flagellated protozoan
78
How is Giardia spread?
Faeco-orally
79
How is Giardiasis treated?
Metronidazole
80
How can one diagnose Giardiasis?
1. Stool microscopy for trophozoite and cysts are classically negative
2. Duodenal fluid aspirates
3. String tests (fluid absorbed onto swallowed string)
81
What blood findings are suggestive of legionella?
1. Hyponatraemia
| 2. Deranged LFTs
82
What are some clinical features of Legionnaire's disease?
1. Flu-like symptoms
2. Fever
3. Dry cough
4. Relative bradycardia
5. Confusion
83
How is Legionnaire's disease diagnosed?
Urinary antigens
84
What is the management of Legionnaire's disease?
Erythromycin/clarirthromycin
85
What causes spread of malaria?
The female Anopheles mosquito
86
What are 4 different species of Plasmodium that cause malaria in man?
1. Falciparum
2. Vivax
3. Ovale
4. Malariae
87
What is a protective factor against malaria infection?
G6PDD
88
What is the most prevalent STI in the UK?
Chlamydia trachomatis
89
What percentage of young women in the UK have chlamydia?
10%
90
What is the incubation period of chlamydia?
7-21 days
91
In what percentage of men and women is chlamydia asymptomatic?1
1. Women = 70%
| 2. Men = 50%
92
What are some features of chlamydia infection in women and men?
1. Women = cervicitis (bleeding, discharge), dysuria
| 2. Men = urethral discharge, dysuria
93
What are some potential complications of chlamydia in women?
1. PID
2. Endometritis
3. Increase incidence of ectopic pregnancies
4. Infertility
5. Perihepatitis (FHC syndrome)
6. Reactive arthritis
94
What are some potential complications of chlamydia in men?
1. Epididymitis
2. Infertility
3. Reactive arthritis
95
What is the investigation of choice for chlamydia?
NAAT
1. Vulvovaginal swab in women
2. Urine test in men
96
What age group is the national Chlamydia screening programme open to in the UK?
15-24 y/o
97
What is the abx management of chlamydia?
Doxycylcine (7d) or azithromycin (single dose)
98
What is the abx management of chlamydia in pregnancy?
Azithromycin 1g stat
99
Who should be contacted for men with urethral symptoms due to Chlamydia?
All contact since and in the 4 weeks prior to onset of symptoms
100
Who should be contacted for women and asymptomatic men with Chlamydia?
All partners from the last 6 months or the most recent sexual partner
101
How should contacts of confirmed Chlamydia cases be treated?
Treat then test
102
What should be pts with suspected meningococcal meningitis be given if in a GP surgery?
IM benpen
103
What is the management of meningitis?
IV cefotaxime
104
What is the management of Listeria meningitis?
IV amoxicillin + gentamicin
105
What should be given to pts with meningitis to reduce the risk of neurological sequelae?
IV dexamethasone
106
Which contacts of a meningitis pt should be treated?
1. Prophylaxis to household and close contacts
| 2. Prophylaxis to those exposed to respiratory secretions
107
What is the abx prophylaxis for close contacts of a meningitis pt?
1. Oral ciprofloxacin/rifampicin
| 2. If they have been in contact in 7 days before onset
108
How many types of influenza virus are there?
3: A, B, C
109
Which influenza virus subtypes account for the majority of clinical disease?
A and B
110
What are the features of the paediatric influenza vaccine?
1. Given intranasally
2. First dose at 2-3 y/o then annually after that
3. Is a live vaccine
111
What is an allergy that is a c/i to receiving paediatric influenza vaccine?
Egg allergy
112
What is the valency of the adult influenza vaccine and what are its components?
Trivalent, with 2 subtypes of Influenza A and 1 of Influenza B
113
What kind of vaccine is the adult influenza vaccine?
Inactivated
114
What is a c/i to the adult influenza vaccine?
Hypersensitivity to egg protein
115
What is the efficacy of the adult influenza vaccine?
75%
116
How many days after influenza vaccination are antibodies at protective levels?
10-14 days
117
How should UTI in pregnancy be managed?
Nitrofurantoin
118
How is a UTI normally treated in non-pregnant women?
Trimethoprim/nitrofurantoin for 3 days
119
What does OPSI stand for?
Overwhelming post splenectomy infection
120
When is the risk of OPSI the greatest?
In the first 2 years following splenectomy
121
What infections are splenectomy pts particularly at risk of?
1. Pneumococcus
2. Meningococcus
3. Haemophilus
122
What abx prophylaxis is given for splenectomy pts?
Penicillin V
123
What vaccinations should be offered to splenectomy pts?
1. HiB
2. Men A & C
3. Annual influenza
4. Pneumococcal every 5 years
124
What are some indications for splenectomy?
1. Trauma
2. Spontaneous rupture (EBV)
3. Hypersplenism (hereditary spherocytosis)
4. Malignancy (lymphoma/leukaemia)
5. Splenic cysts/hydatid cysts/splenic abscesses
125
What are 4 complications of splenectomy?
1. Haemorrhage
2. Pancreatic fistula (due to damage to pancreatic tail)
3. Thrombocytosis (prophylactic aspirin)
4. Encapsulated bacteria infection
126
When should anti-retroviral therapy be started for HIV?
At the time of diagnosis
127
What combination of drugs does HAART usually entail?
1. 2 nucleoside reverse transcriptase inhibitors (NRTIs)
AND
2. Protease inhibitor OR NNRTI
128
What is an entry inhibitor for HIV?
Maraviroc
129
What is the MOA of Maraviroc?
Binds to CCR5, preventing interaction with gp41
130
What is enfuvirtide?
A fusion inhibitor, binds to gp41
131
What are some examples of NRTIs (nucleoside analogue reverse transcriptase inhibitors)?
1. Zidovudine
2. Abacavir
3. Emtricitabine
4. Lamivudine
5. Stavudine
6. Tenofovir
132
What is a general side effect of NRTIs?
Peripheral neuropathy
133
What are 2 s/es of tenofovir?
Renal impairment and osteoporosis
134
What are 3 s/e of zidovudine
1. Anaemia
2. Myopathy
3. Black nails
135
What are 2 examples of NNRTIs?
1. Nevirapine
| 2. Efavirenz
136
What are some protease inhibitors?
1. Ritonavir
| 2. Indinavir
137
What is a s/e of ritonavir?
P450 inhibitor
138
What is an example of an integrase inhibitor?
Raltegravir
139
What is the most appropriate diagnostic test for mycoplasma?
1. Serology
| 2. Cold agglutination test
140
What are 2 characteristic complications of Mycoplasma pneumoniae?
1. Erythema multiforme
| 2. Cold AIHA
141
What are atypical lymphocytes suggestive of?
Glandular fever
142
What are 3 causes of glandular fever?
1. EBV (90%)
2. CMV
3. HHV6
143
What is the classic triad of infectious mononucleosis?
1. Sore throat
2. Pyrexia
3. Lymphadenopathy
144
What percentage of pts with infectious mononucleosis have splenomegaly?
50%
145
What develops in 99% of pts with infectious mononucleosis if they take ampicillin/amoxicillin?
A maculopapular, pruritic rash
146
How is infectious mononucleosis diagnosed?
Heterophile antibody test (Monospot test)
147
What is the management of infectious mononucleosis?
1. Rest, fluid, avoid alcohol
2. Simple analgesia for aches or pains
3. Avoid contact sports for 8 weeks
148
Which 2 vaccinations are routinely offered to pregnant women in the UK?
Influenze and pertussis
149
What is the abx of choice for UTIs post-partum?
Trimethoprim (is present in milk but not harmful)
150
What is the MOA of trimethoprim?
Dihydrofolate reductase inhibitor
151
What are 2 s/e of trimethoprim?
1. Myelosuppression
2. Transient rise in creatinine
3. Hyperkalaemia
152
Why does trimethoprim cause a transient rise in creatinine?
It competitively inhibits the tubular secretion of creatinine resulting in a temporary increase (blocks ENaC channel in the distal nephron), also leading to hyperkalaemia
153
What status is very important in the management of bites?
Tetanus status
154
To whom should IM human tetanus Ig be given to in A&E?
High risk wounds e.g. compound fractures, significant degree of devitalised tissue
155
What is the dosage for Abx prophylaxis in splenectomy pts?
1. Penicillin V 500mg BD
| 2. Amoxicillin 250mg BD
156
A pt goes somewhere sunny and develops a cold sore, why?
Sunlight is a common trigger for cold sores
157
How can you classify the causes of diarrhoea in HIV?
1. HIV enteritis
| 2. Opportunistic infection
158
What are some opportunistic infections that can cause diarrhoea in HIV?
1. Cryptosporidium and other protozoa (most common)
2. CMV
3. MAI
4. Giardia
159
What is the most common infective cause of diarrhoea in HIV pts?
Cryptosporidium
160
When is MAI infection typically seen in HIV?
When CD4 count is <50
161
How is MAI managed?
1. Rifabutin
2. Ethambutol
3. Clarithromycin
162
What is a good initial IV bolus to give for HIV?
500ml over 15min
163
For every hour that IV Abx are delayed for sepsis, what is the percentage increase in mortality?
8%
164
How can you define traveller's diarrhoea?
3 loose to watery stools in 24 hours
165
What is the most common cause of traveller's diarrhoea?
E coli
166
What are 3 causes of acute food poisoning?
1. B. cereus
2. S. aureus
3. C. perfringens
167
What is the typical hx for giardiasis?
1. Prolonged, non-bloody diarrhoea
| 2. Chronic diarrhoea, malabsorption and lactose intolerance can occur
168
What is the typical hx for shigella?
Bloody diarrhoea, vomiting and abdo pain
169
What is the typical hx for campylobacter?
Flu-like prodrome usually followed by crampy abdo pain, fever, and diarrhoea (can be bloody)
170
What condition may a campylobacter infection mimic?
Appendicitis
171
What is a complication of campylobacter infection?
Guillain-Barre syndrome
172
What is the typical history for amoebiasis?
Gradual onset bloody diarrhoea, abdo pain and tenderness which may last for several weeks
173
Reheated rice and diarrhoea cause?
Bacillus cereus
174
What is the MOA by which B. cereus causes diarrhoea in reheated rice?
Their spores germinate in cooked rice and produce toxin if the cooked product is kept insufficiently chilled
175
What is the the standard therapy for TB?
1. RIPE 2 months
| 2. RI 4 months
176
What is the treatment for latent TB?
1. RI for 3 months OR
| 2. I for 6 months
177
When may directly observed therapy be used for TB treatment?
3x a week dosing regimen
1. Homeless with active TB
2. Pts with poor compliance
3. All prisoners
178
How does dengue usually present?
Fever and joint pains
179
How does leptospirosis usually present?
1. Biphasic pattern of fever and headaches
| 2. Continuing muscle and abdo pain
180
What causes typhoid?
Salmonella typhi
181
What causes paratyphoid?
Salmonella paratyphi
182
How is typhoid transmitted?
Faeco-oral route
183
What are some distinguishing features of typhoid infection?
1. Relative bradycardia
2. Constipation
3. Rose spots (40% pts, more common in paratyphoid)
184
When should re-infection with syphilis be suspected?
If the RPR test rises by 4-fold or more
185
What is the RPR test?
Rapid plasma reagin test
186
What does the Enzyme Immunoassay Test (EIA) for syphilis measure?
Acute IgM Ab to syphilis, may be negative in reinfection
187
What is the TPPA test?
T. Pallidum particle agglutination test, often remains positive in pts who have been previously infected
188
What is the 1st line treatment for syphilis?
IM Benpen
189
What is the management of gonorrhoea?
IM ceftriaxone 1g (+ oral azithromycin, depending on guideline)
190
How can you classify serological tests for syphilis?
1. Cardiolipin test = VDRL, RPR
| 2. Treponemal specific Ab tests = TPHA
191
How long does HIV seroconversion take?
3-12 weeks
192
What is seroconversion?
The period where an antibody response is created and is detectable
193
If pts take an ELISA test and are HIV negative, when are they recommended to retake the test to confirm they are HIV free?
After 3 months
194
In what percentage of pts is HIV seroconversion symptomatic?
60-80%
195
What are the typical symptoms of HIV seroconversion?
1. Sore throat
2. Lymphadenopathy
3. Malaise, myalgia, arthralgia
4. Diarrhoea
5. Maculopapular rash
6. Mouth ulcers
7. Rarely meningoencephalitis
196
What bacterium is the cause of immune-mediated neurological disease after a pneumonia?
Mycoplasma pneumoniae
197
What are 5 live attenuated vaccines?
1. BCG
2. MMR
3. Oral polio
4. Oral typhoid
5. Yellow fever
198
What are three toxoid (inactivated toxin) vaccines?
1. Tetanus
2. Diphtheria
3. Pertussis
199
Abx tx for exacerbation of chronic bronchitis?
Amoxicillin or clarithromcyin
200
Abx tx for uncomplicated CAP?
Amoxicillin
201
Abx tx for atypical pneumonia?
Clarithromycin
202
Abx tx for for HAP?
1. W/in 5 days of admission = co-amoxiclav or cefuroxime
| 2. >5d after admission = Piptaz OR Cipro OR Ceftazidime
203
Abx tx for acute prostatitis?
Quinolone or tripmethoprim
204
Abx tx for for cellulitis?
Flucloxacillin
205
Abx tx for for cellulitis near eye or nose?
Co-amoxiclav
206
Abx tx for erysipelas?
Flucloxacillin
207
Abx tx for animal/human bite?
Co-amoxiclav
208
Abx tx for mastitis during breast feeding?
Flucloxacillin
209
Abx tx for throat infections?
Phenoxymethylpenicillin
210
Abx tx for sinusitis?
Amoxicillin
211
Abx tx for otitis media?
Amoxicillin
212
Abx tx for otitis externa?
Flucloxacillin
213
Abx tx for periodontal/periapical abscess?
Amoxicillin
214
Abx tx for acute necrotising ulcerative gingivitis?
Metronidazole
215
Abx tx for chlamydia?
Doxycycline
216
Abx tx for PID?
IM ceftriaxone + oral doxycycline + oral metronidazole
217
Abx tx for syphilis?
IM benpen
218
Abx tx for C.diff?
1. First episode = metronidazole
| 2. Second/subsequent episode = vancomycin
219
Abx tx for campylobacter enteritis?
Clarithromycin
220
Abx tx for for salmonella (non-typhoid)?
Ciprofloxacin
221
Abx tx for shigellosis?
Ciprofloxacin
222
How many tetanus doses confers lifelong protection?
5
223
What are genital warts also known as?
Condylomata accuminata
224
What are the main HPV subtypes that cause genital warts?
HPV 6 & 11
225
What do genital warts look like?
Small, 2-5mm fleshy protuberances which are slightly pigmented that may bleed or itch
226
What is the management of genital warts?
1. Multiple non-kersatinised warts = topical podophyllum
2. Solitary, keratinised warts = cryotherapy
3. Second line = topical imiquimod
227
What are pearly penile papules?
A normal variant of the glans, do not require intervention, and are not caused by any form of virus
228
What causes LGV?
Chlamydia trachomatis
229
What are the 3 stages of lymphogranuloma venereum?
1. Small painless pustule which later forms an ulcer
2. Painful inguinal lymphadenopathy
3. Proctocolitis
230
How is LGV treated?
Doxycycline
231
What are some causes of genital ulcers?
1. Infective = genital herpes, syphilis, chancroid, LGV, granuloma inguinal
2. Inflammation = Behcet's disease
3. Malignancy
232
What causes granuloma inguinale?
Klebsiella granulomatis
233
What virus causes Kaposi's sarcoma?
HHV8
234
How does Kaposi's sarcoma present?
Purple papules or plaque on the skin or mucosa
235
What are the respiratory complications of Kaposi's sarcoma|?
Haemoptysis and pleural effusion
236
What is the management of Kaposi's sarcoma?
Radiotherapy and resection
237
Is rifampicin a potent liver enzyme inhibitor or inducer?
Inducer
238
What blood findings are typical of dengue?
Low platelet count and raised transaminases
239
How does dengue typically present?
1. Retro-orbital headache
2. Fever
3. Myalgia
4. Pleuritic pain
5. Facial fluhing
6. Maculopapular rash
240
What is the treatment of dengue?
Entirely symptomatic (fluid resus, blood transfusion etc.), no antiviral are currently available
241
What transmits dengue?
Aedes aegypti mosquito
242
What is the incubation for dengue?
7 days
243
What is the mainly complicatoin of dengue?
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
What are the EBV-associated malignancies?
1. Burkitt's lymphoma
2. Hodgkin's lymphoma
3. HIV-associated CNS lymphomas
4. Nasopharyngeal carcinoma
245
How can you treat pts with cellulitis who are penicillin allergic?
Clarithromycin or clindamycin
246
What classification system can be used to guide treatment of cellulitis?
Eron classification
247
Which Eron classification classes suggests pts should be given IV Abx?
Class III or IV
248
What causes Lyme disease?
Borrelia burgdorferi
249
What transmits Borrelia?
The Ixodes tick
250
How can you classify the features of Lyme disease?
1. Early = ECM in 80%, fever, arthralgia
2. Cardiovascular = heart block, myocarditis
3. Neurological = facial nerve palsy, meningitis
251
How is lyme diagnosed?
ELISA --> if positive, then an immunoblot test for Lyme disease should be done
252
What is the management of Lyme disease?
14-21 day course of oral Doxycycline
253
What is sometimes seen after initiating Lyme management??
The Jarisch-Herxheimer reaction
254
What is the Jarisch-Herxheimer reaction?
A reaction to endotoxin-like products released by the death of harmful microorganisms within the body during antibiotic treatmen
255
After treatment of what disease is the Jarisch-Herxheimer reaction typically seen?
Syphilis
256
What are some symptoms of the Jarisch-Herxheimer reaction?
After the first dose of antibiotic:
1. Fever
2. Rash
3. Tachycardia
257
What is N. meningitidis?
A gram negative diplococcus
258
What is S. pneumoniae?
A gram positive diplococcus/chains
259
What is E.coli?
A gram negative baciilli
260
What is H. influenzae?
A gram negative coccobacilli
261
What is L. monocytogenes?
A gram positive rod
262
What is the management for women who present with a primary herpes infection in their third trimester of pregnancy?
1. Oral ACV 400mg TDS until delivery
| 2. Elective CS
263
What is a typical finding on CXR of legionella infection?
Pleural effusion
264
What is malorone?
Atovaquone and proguanil
265
What are some malaria treatments?
1. Malorone
2. Chloroquine
3. Doxycycline
4. Mefloquine (Lariam)
5. Proguanil
6. Proguanil + Chloroquine
266
What antimalarial is taken once weekly?
Mefloquine (Lariam)
267
What antimalarial should be avoided if the pt has a history of depression?
Mefloquine (Lariam)
268
What is the main s/e of malorone?
GI upset
269
Bilateral conjunctivitis, bilateral calf pains and high fevers in a sewage worker>
Leptospirosis
270
What are some features of fulminant leptospirosis (Weil's disease)?
1. Hepatitis --> jaundice
2. Pulmonary haemorrhage
3. AKI
271
What are some features of mild/anicteric leptospirosis?
1. Bilateral conjunctivitis
2. Bilateral calf pain
3. high fever
272
How is leptospirosis transmitted?
Contact of broken skin with urine of infected rodents
273
What percentage of pts with mild/anicteric lepto go on to develop fulminant lepto (Weil's disease)?
10%
274
What is the management of leptospirosis?
High dose benzylpenicillin or doxycycline
275
What causes leptospirosis?
Leptospira interrogans
276
What is hairy leukoplakia?
An EBV-associated lesion on the side of the tongue that is considered indicative of HIV
277
What is the incubation period of yellow fever?
2-14 days
278
How is yellow fever spread?
Aedes mosquito
279
What are some features of yellow fever?
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
What may seen in the hepatocytes in yellow fever?
Councilman bodies (inclusion bodies)
281
What is the commonest cause of viral encephalitis?
HSV
282
What viruses does the enterovirus family contain?
1. Coxsackie
2. Echovirus
3. Rhinovirus
283
What are enteroviruses?
Positive-sense ssRNA virus
284
What is the most common cause of bronchiolitis?
RSV
285
What is the most common cause of croup?
Parainfluenza virus
286
What is the most common cause of the common cold?
Rhinovirus
287
What is the most common cause of bronchiectasis exacerbations?
H. influenzae
288
What is the most common cause of pyelonephritis?
E. coli
289
What causes tetanus?
Release of tetanospasmin exotoxin from Clostridium tetani
290
What is the MOA of tetanospasmin?
Prevents release of GABA
291
What are some features of tetanus?
1. Prodrome fever, lethargy, headache
2. Trismus (lockjaw)
3. Risus sardonicus
4. Opisthotonus (arched back, hyperextended neck)
5. Spasms (dysphagia)
292
What is the management of tetanus?
1. Supportive incl. ventilatory support and muscle relaxants
2. IM human tetanus Ig for high risk wounds
3. Metronidazole (now preferred to benpen)
293
What are some risk factors for invasive aspergillosis?
1. HIV
2. Leukaemia
3. Following broad spectrum Abx
294
What are 3 species of Aspergillus?
1. Fumigatus
2. Flavus
3. Terreus
295
What is an aspergilloma?
A mycetoma (mass-like fungus ball) which often colonises an existing lung cavity (e.g. secondary to TB, lung cancer, CF)
296
What is the triad of Behcets disease?
1. Oral ulcers
2. Genital ulcers
3. Anterior uveitis
4. VTE is also seen
297
Where can gonorrhoea present?
Any mucous membrane surface, typically GU but also the rectum and pharynx
298
What are some features of gonorrhoea?
1. Males = urethral discahrge, dysuria
2. Females = cervicitis --> vaginal discharge
3. Rectal and pharyngeal infection usually asymptomatic
299
What are some complications of gonorrhoea?
1. Local = urethral strictures, epididymitis, salpingitis
| 2. Systemic = Disseminated gonococcal infection (DGI) and gonococcal arthritis
300
What is the classic triad of sx of disseminated gonococcal infection (DGI)?
1. Tenosynovitis
2. Migratory polyarthritis
3. Dermatitis
301
What is the rabies virus?
An RNA rhabdovirus
302
How does rabies travel to the CNS?
Following a bite, the virus travels up the nerve axons towards the CNS in a retrograde fshion
303
What are some features of rabies?
1. Prodrome = headache, fever, agitation
2. Hydrophobia = water-provoking muscle spasms
3. Hypersalivation
304
What do you see in neurones infected by rabies?
Negri bodies (cytoplasmic inclusion bodies)
305
What is the management of an animal bite in a country at-risk of rabies?
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
What infection does strep pyogenes rarely cause?
Pneumonia
307
What does BCG stand for?
Bacille Calmette-guerin
308
What does the BCG vaccine contain?
Live attenuated Mycobacterium bovis
309
What does the BCG vaccine also offer limited protection against?
Leprosy
310
What are some contraindications to the BCG vaccine?
1. Previous BCG vaccinations
2. Past hx of TB
3. HIV
4. Pregnancy
5. Positive tuberculin test
311
Over what age group is the BCG vaccine not given due to no evidence to suggest it works?
>35 y/o
312
Do children >6y/o require a tuberculin skin test prior to receiving the BCG vaccine?
Yes
313
What does JC virus cause in an immunocompromised pt?
Progressive multifocal leukoencephalopathy
314
How can you classify HIV opportunistic infection?
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
What are some 200 - 500 cells/mm3 HIV infections?
1. Oral thrush (C. albicans)
2. Shingles (HZV)
3. Hairy leukoplakia (EBV)
4. Kaposi's sarcoma (HHV8)
316
What are some 100 - 200 cells/mm3 HIV infections?
1. Cryptosporidiosis
2. Cerebral toxoplasmosis
3. PML (JCV)
4. PCP
5. HIV dementia
317
What are some 50 - 100 cells/mm3 HIV infections?
1. Aspergillosis
2. Oesophageal candidiasis
3. Cryptococcal meningitis
4. Primary CNS lymphoma (EBV)
318
What are some 0 - 50 cells/mm3 HIV infections?
1. CMV retinitis (30-40%)
| 2. MAI infection
319
What is black hairy tongue?
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
What are some predisposing factors for black hairy tongue?
1. Poor oral hygiene
2. Smoking
3. IVDU
4. Abx (paritcularly tetracyclines)
321
What are some s/e of tetracyclines?
1. Discoloration of teeth (so shouldnt be used in children <12y/o)
2. Photosensitivity
3. Angiodema
4. Black hairy tongue
322
What are some indications of tetracyclines?
1. Acne
2. Lyme disease
3. Chlamydia
4. Mycoplasma
323
Which of the hepatitides is most commonly spread by undercooked pork?
Hep E
324
What kind of vaccine is influenza?
Inactivated
325
What are 3 conjugate vaccines?
1. Pneumococcus
2. Haemophilus
3. Meningococcus
326
What abx class causes photosensitivity?
Tetracyclines
327
Are X-ray changes in Pneumocystis jiroveci pneumonia generally too subtle for non-radiologists to detect
Yes
328
What is an SBA finding of PCP?
Exercise-induced desaturation
329
How may Kaposi's sarcoma present in children?
Only generalised lymphadenopathy, suggestive of lymphoma
330
What causes the blue-green colour with Pseudomonas infections?
The pigment pyocyanin
331
What is pseudomonas aeruginosa?
A gram negative rod
332
How does pseudomonas exert its deleterious effects?
Produces both an endotoxin and exotoxin
333
What is the likely causative organism of a chest infection in CF?
Pseudomonas aeruginosa
334
How can you differentiate anaphylaxis from a Jarisch-Herxheimer reaction?
There is no wheeze or hypotension in the JHR
335
What is the management of a Jarisch-Herxheimer reaction?
No treatment other than antipyretics PRN
336
When should vaccines be given before an elective splenectomy?
Two weeks before surgery
337
What is the incubation period of Hep A?
2-4 weeks
338
What kind of virus is Hep A?
RNA picornavirus
339
What are the features of Hep A?
1. Flu-like prodrome
| 2. Jaundice, hepatosplenomegaly
340
What are the complications of Hep A?
Complications are very rare and there is no increased risk of HCC
341
How would you treat 12 weeks pregnant lady with syphilis?
IM benzathine penicillin G
342
What are some occupations that get leptospirosis?
1. Sewage workers
2. Farmers
3. Vets
4. Abattoir workers
343
What do you give for an animal or human bite in the UK?
Co-amoxiclav
344
What is the most commonly isolated organism from an animal bite?
Pasteurella multocida
345
What is the most common neurological infection seen in HIV?
Cerebral toxoplasmosis (10%)
346
Pt with HIV, neuro symptoms, multiple brain lesions with ring enhancement?
Cerebral toxoplasmosis
347
What is the management for cerebral toxoplasmosis?
Sulfadiazine and pyrimethamine
348
What neuro malignancy is associated with an EBV infection in HIV?
Primary CNS lymphoma
349
How can you differentiate between primary CNS lymphoma and cerebral toxoplasmosis in an HIV pt?
1. Toxoplasmosis = multiple lesions, ring or nodular enhancement, thallium SPECT negative
2. Lymphoma = single lesion, solid homogeneous enhancement, thallium SPECT positive
350
What is the most common fungal infection of the CNS in HIV?
Cryptococcus
351
What do you see on CSF in cryptococcus?
High opening pressure, India Ink test positive
352
What is the pathophysiology of PML?
Widespread demyelination due to infection of oligodendrocytes by JCV (a polyoma DNA virus)
353
What do you see on CT of AIDS dementia complex?
Cortical and subcortical atrophy
354
What is the main technique used for screening of latent TB?
The Mantoux test
355
What produces a false positive of the Mantoux test?
1. Miliary TB
2. Sarcoidosis
3. HIV
4. Lymphoma
5. Very young age (<6m)
356
Has the Heaf test been discontinued?
Yes
357
How is the Mantoux test performed?
0.1ml of 1:1000 purified protein derivative (PPD) injected intradermally, and the result is read 2-3 days later
358
How is the the mantoux test interpreted?
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
What cell count is diagnostic of a UTI?
Pure growth >10^5 organisms/mL on a MSU
360
What kind of virus is Hep C?
RNA flavivirus
361
What is the incubation period of Hep C?
6-9 weeks
362
What is the risk of transmission of Hep C during a needlestick?
2%
363
What is the risk of transmission of Hep C from mother to child?
6%
364
How is chronic Hep C defined?
Persistence of HCV RNA in the blood for 6 months
365
What are some complications of Hep C?
1. Rheum = arthralgia, arthritis
2. Eyes = Sjogrens
3. Liver = cirrhosis, HCC
4. Cryoglobulinaemia - typically Type II
5. PCT
6. Membranoproliferative GN
366
What is the management of chronic Hep C?
1. Depends on viral genotype
| 2. Protease inhibitor with or without ribavarin
367
What is the goal of Hep C treatment?
A sustained virologic response (SVR)
368
How is Sustained virologic response (SVR) defined?
Undetectable serum HCV RNA 6m after the end of therapy
369
What are 2 s/e of ribavarin?
1. Haemolytic anaemia
| 2. Cough
370
What is the single most effective step at reducing the incidence of MRSA?
Hand hygeine
371
Which pts should be screened for MRSA?
All pts awaiting elective admissions
372
How is MRSA suppressed from a carrier one identified?
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
What are 3 drugs commonly used in the treatment of MRSA infections?
1. Vancomycin
2. Linezolid
3. Teicoplanin
374
At what CD4 level does PCP usually occur?
<200 cells/mm3
375
What organisms are visualised by India-Ink staining?
Cryptococcus
376
How can HIV be diagnosed?
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
When is the HIV antibody test positive?
Most people develop Abs to HIV at 4-6 weeks byt 99% do by 3 months
378
When is the HIV p24 antigen test positive?
From about 1 week to 3-4 weeks after infection with HIV
379
Following treatment for syphilis, what happens to TPHA and VDRL?
1. TPHA remains positive
| 2. VDRL becomes negative
380
What is TPHA?
Treponema Pallidum Haemagglutination Assay
381
What are high risk areas for Lyme disease in the UK?
South of England and the Scottish Highlands
382
Is the presence of erythema migrans sufficient to begin treating a pt for Lyme disease?
Yes
383
What is determined to be severe falciparum malaria?
High parasitaemia (>2%) and various other derangements
384
What is the 1st line management for severe falciparum malaria?
IV artesunate
385
What is the management of non-severe falciparum malaria?
Oral artesunate combination therapy (ACT)
386
What are some complications of falciparum malaria?
1. Cerebral malaria = seizures, coma
2. AKI = blackwater fever secondary to intravascular haemolysis
3. ARDS
4. DIC
5. Hypoglycaemia
387
What is an example of an artesunate combination therapy?
Artemether + lumefantrine
388
What is recommended if falciparum parasite count is >10%?
Exchange transufusion
389
What might shock in malaria indicate?
Coexistent bacterial septicaemia (as malaria rarely causes haemodynamic collapse)
390
Is there a risk of HCC with Hep A?
No
391
What is the most likely cause of a persistent PUO and lymphadenopathy with high WCC?
Lymphoma
392
What is the commonest type of malaria?
Falciparum
393
How can E coli be classified?
According to antigens which may trigger an immune response: O, K, H
394
What imaging is required to diagnose a suspected spinal epidural abscess?
Full spine MRI to search for skip lesions
395
What is an abscess?
A collection of pus encapsulated by a pyogenic membrane
396
What is a spinal epidural abscess (SEA)?
A collection of pus that is superficial to the dura mater
397
How does an spinal epidural abscess arise?
1. Contiguous from adjacent structures e.g. discitis
2. Haematogenous e..g bacteraemia from IVDU
3. Direct e.g. surgeyr
398
What is the most common causative organism of a spinal epidural abscess?
S. aureus
399
What is the triad of presentation of a spinal epidural abscess?
1. Fever
2. Back pain
3. Focal neurological deficits according to the segment of the cord affected
400
What is PEP for HIV?
Oral antiretroviral therapy for 4 weeks ASAP after exposure
401
How much does PEP for HIV reduce risk of transmission?
80%
402
What causes amoebiasis?
Entamoeba histolyca
403
How is amoeba spread?
Faeco-oral
404
What percentage of the world is chronically infected with entamoeba?
10%
405
When abscess does amoeba cause?
Liver and colonic
406
What are 3 presentations of amoeba?
1. Asymptomatic
2. Mild diarrhoea
3. Amoebic dystentery
4. Amoebic liver abscess
407
How does amoebic dysentery present?
1. Profuse, bloody diarrhoea
2. Long incubation period
3. Hot stool may show trophozoites
408
How is amoebic dysentery treated?
Metronidazole
409
How are the contents of an amoebic liver abscess described?
Anchovy sauce
410
What are some features of an amoebic liver abscess?
1. Fever and RUQ
| 2. Serology is positive in 90%
411
How is an amoebic liver abscess treated?
1. Luminal amoebicide to eradicate the cystic stage which is resistant to metronidazole and tinidazole
2. Metronidazole
412
What is the incubation period of Ebola virus?
2-21 days
413
What virus family is ebola part of?
Filoviridae
414
What is the average fatality of ebola in pervious outbreaks?
50%
415
How does ebola spread?
Human to human spread via direct contact through broken skin or mucous membranes (including contaminated bedding, clothing and surfaces)
416
When do ebola pts become infectious?
When they develop symptoms
417
What abx should be added in the treatment of pneumonia if secondary to influenza?
Flucloxacillin
418
What is the most common complication of gonorrhoea?
Subfertility secondary to PID
419
When can babies born to mothers with known HIV be described as seronegative?
If they are negative at birth, 3m, 6m, and at 18m
420
When should HIV in asymptomatic patients be done?
4 weeks after possible exposure
421
What are 3 metabolic abnormalities caused by cholera?
1. Hypokalaemia
2. Hypoglycaemia
3. Metabolic acidosis
422
What is the management of cholera?
1. Oral rehydration therapy
| 2. Abx = doxycycline, ciprofloxacin
423
What is vibrio cholerae?
A gram negative bacteria
424
Man returns from kenya with maculopapular rash and flu-like illness?
HIV seroconversion
425
What tests must be done prior to starting TB therapy?
1. FBC = baseline and plt count due to hepatotoxicity
2. LFTs = hepatotoxicity
3. U&Es = baseline, Cr elevation
4. Vision testing = ethambutol
426
What is the most common cause of diarrhoea in pts with HIV infection?
Cryptosporidium
427
What is co-trimoxazole?
Trimethoprim and Sulfamethoxazole
428
Renal transplant pt with blurring of vision?
CMV Retinitis
429
When would you see a stormy sunset appearance on fundoscopy?
Central retinal vein occlusion (CRVO)
430
When would you see a pizza pie appearance on fundoscopy?
CMV
431
What is are the features of CMV retinitis on fundoscopy?
Pizza-pie appearance, a mixtureof:
1. Cotton wool spots
2. Infiltrates
3. Haemorrhages
432
What percentage of people have been exposed to CMV?
50%, though only causes disease in the immunocompromise
433
What are the patterns of CMV disease?
1. Congenital CMV infection
2. CMV mononucleosis
3. CMV retinitis
4. CMV encephalopathy
5. CMV pneumonitis
6. CMV colitis
434
When would you see pinpoint petechial 'blueberry muffin' skin lesions?
Congenital CMV infection
435
What is the treatment of choice for CMV retinitis?
IV ganciclovir
436
A child has parvovirus B19 infection, how should you manage the pregnant mother?
Check maternal IgM and IgG
437
What spreads Leishmaniasis?
Sand flies
438
What are some subtypes of Leishmania?
1. Tropica
2. Mexicana
3. Braziliensis
4. Donovani
439
What are 3 forms of leishmaniasis?
1. Cutaneous
2 Mucocutaneous
3. Visceral (Kala-azar)
440
What typically causes cutaneous leishmaniasis?
L tropica/mexicana
441
What typically causes mucocutaneous leishmaniasis?
L braziliensis
442
What typically causes visceral leishmaniasis?
L. donovani
443
Return from south america with ulcerating lesions in lower lip, oral and nasal mucosa?
Mucocutaneous leishmaniasis
444
What are some complications of mycoplasma infection?
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
What needs to be checked before commencing a pt on terbinafine to treat a fungal nail infection?
LFTs
446
What are 2 animal reservoirs for toxoplasma gondii?
Cats and rats
447
What are some features of toxoplasmosis?
1. Glandular fever features
2. Meningoencephalitis
3. Myocarditis
448
How does toxoplasma gondii enter the body?
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
What is the most common cause of oesophagitis in pts with HIV?
Oesophageal candidiasis
450
What are the 1st line treatments for oesophageal candidiasis?
Fluconazole and itroconazole
451
Does an appendicectomy require prophylactic abx?
Yes
452
What is a cause of Type III necrotising fasciitis?
Vibrio vulnificus
453
What is clostridia?
Gram positive, obligate anaerobic bacilli
454
What are some features of C. perfringens?
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
What are some features of C. botulinum?
1. Typically seen in canned foods and honey
| 2. Prevents ACh release, leading to flaccid paralysis
456
What are some features of C. difficile?
1. Causes pseudomembranous colitis, typically seen after use of BSA
2. Produces exotoxin and cytotoxin
457
What are some features of C. tetani?
Produces an exotoxin (tetanospasmin) that prevents the release of glycine from Renshaw cells in the spinal cord causing a spastic paralysis
458
What are 4 clostridium species?
1. Perfringens
2. Botulinum
3. Difficile
4. Tetani
459
What is the most common complication of mumps in pot-pubertal males?
Orchitis
460
What kind of virus is mumps?
RNA paramyxovirus
461
How is mumps spread?
1. Droplets
2. Respiratory tract epithelial cells --> parotid glands --> other tissues
3. Incubation period 14-21 days
462
What are some clinical features of mumps?
1. Fever
2. Malaise, muscular pain
3. Parotitis (earache/pain on eating), unilateral --> bilateral
463
What is the management of mumps?
1. Rest
| 2. Paracetamol for high fever/discomfort
464
What are 4 complications of mumps?
1. Orchitis
2. Pancreatitis
3. Hearing loss (unilateral and transient)
4. Meningoencephalitis
465
How can you classify causes of gastroenteritis based upon incubation period?
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
What is the relative bradycardia you see in typhoid fever called?
Faget's sin
467
What condition presents with 'pea green diarrhoea'?
Typhoid
468
After an initial negative result when testing for HV in an asymptomatic pt, when should you offer a repeat test?
12 weeks post expsosure
469
When should HIV testing in asymptomatic patients be done after exposure?
4 weeks after exposure
470
Why does amoebiasis lead to 'anchovy sauce' in the liver abscess?
E. histolytica digests hepatic tissue
471
What is a complication of measles that can arise many years in the future?
Subacute sclerosing panencephalitis
472
What is the classic triad of sx of glandular fever seen in 98% of pts?
1. Sore throat
2. Lymphadenopathy
3. Pyrexia
473
What are the gram positive rods?
ABCD L
1. Actinomyces
2. Bacillus anthracis
3. Clostridium
4. Corynebacterium diphtheriae
5. Listeria monocytogenes
474
What are the gram negative rods?
1. H. influenzae
2. E. coli
3. P. aeruginosa
4. Salmonella
5. Shigella
6. C. jejuni
475
Fever on alternating days?
Malaria
476
How many phases does typhoid fever typically present with?
4 phases
477
What vaccines should be offered to pts with chronic hepatitis?
1. Annual influenza
| 2. One-off pneumococcal
478
What are 3 inactivated vaccines?
1. Rabies
2. Hep A
3. IM influenza
479
How does S. aureus cause toxic shock syndrome and gastroenteritis respectively?
1. TSS = exotoxin
| 2. Gastroenteritis = enterotoxin
480
What superantigen does S. pyogenes release that causes scarlet fever?
Pyogenic exotoxin A
481
What is an infectious differential for RIF pain with diarrhoea?
C. jejuni
482
What is H. pylori?
A microaerophilic, helix-shaped, gram-negative rod
483
How does H. pylori cause duodenal ulcers?
Colonises gastric antrum --> increased gastrin release --> high levels of gastric acid
484
How does H. pylori cause gastric ulcers?
Diffuse H. pylory infection --> local tissue damage
485
In someone who is colonised with H. pylori, what is the risk of developing a peptic ulcer?
10-20%
486
In someone who is colonised with H. pylori, what is the risk of developing gastric cancer?
1-2%
487
In someone who is colonised with H. pylori, what is the risk of developing a MALT lymphoma?
<1%
488
What is the latest time that HIV PEP may be given?
72 hours after the event
489
What is the abx management of ciprofloxacin?
Ciprofloxacin
490
What abx can be used for traveller's diarrhoea?
Clarithromycin
491
What HHV is EBV?
HHV4
492
What may cause iron deficiency anaemia in pts returning from travel to endemic areas e.g. Indian subcontinent?
Hookworms
493
What kind of parasite is a hookworm?
Nematode
494
How are hookworms acquired?
Skin contact with contaminated soil, commonly from walking barefoot in affected area
495
How do hookworms cause IDA?
Skin --> intestine --> chronic blood loss
496
How can hookworm be diagnosed?
Stool sample for ova, cysts and parasites
497
What kind of vaccine is intranasal influenza?
Live attenuated
498
What is the MOA of ritonavir?
Protease inhibitor
499
What stain do you use to identify mycobacterium tuberculosis?
Ziehl-Neelsen (acid-fast)
500
What is the management of primary CNS lymphoma?
1. Steroids
2. Chemotherapy e.g. methotrexate
3. Radiation
4. Surgery (if lower grade)
501
What is Tazocin?
Piperacillin with Tazobactam
502
What is a use of Tazocin?
Hospital acquired pneumonia
