Passmedicine Flashcards
1
Q
What antibiotics are used to treat MRSA?
A
1st line = vancomycin or teicoplanin.
2nd line = Linezolid
2
Q
what are the main ways of spreading hepatitis?
A
Hepatitis A = Faecal-oral route
Hepatitis B = Sexual transmission
Hepatitis C = Contaminated blood or needles
3
Q
What is the treatment for trichomonas vaginalis
A
Oral metronidazole
4
Q
What is the treatment for gonorrhoea
A
gram negative diplococcus - Neisseria Gonorrhoea:
- IM Ceftriaxone
5
Q
What are the signs of giardiasis?
A
Diarrhoea
Steatorrhoea
Weight loss
Recent travel - Drinking or swimming in water
Lethargy
Bloating
Flatulence
Lactose intolerance
6
Q
What is giardiasis
A
Caused by Giardia lamblia
Spread by faecal oral route
Treated with metronidazole
7
Q
What causes cellulitis
A
Most common = Streptococcus pyogenes
Other = Staphylococcus aureus
8
Q
What is the treatment for cellulitis?
A
Eron Class I:
- Oral flucloxacillin
- Oral clarithromycin, erythromycin (in pregnancy) or doxycycline if penicillin allergic
Eron Class III-IV:
- Admit
- Oral or IV: Co-amoxiclav, Clindamycin, cefuroxime, ceftriaxone
9
Q
What is a sign of EBV?
A
Lymphadenopathy
Pyrexia
Sore throat
Maculopapular pruritic rash in patients who take amoxicillin
10
Q
What are the signs and symptoms of Parvovirus B19
A
Rash - Especially making the cheeks bright red (Very unlikely to involve palms and soles)
Aplastic crisis - In sickle cell disease
Pancytopenia
11
Q
what are the signs of trichomonad vaginalis
A
Vaginal discharge: Offensive, yellow/green, frothy
pH >4.5
Strawberry cervix
Vulvovaginitis
12
Q
what are genital warts
A
Caused by the HPV virus - Especially types 6 and 11.
13
Q
what is the treatment for genital warts
A
1st line = topical podophyllum or cryotherapy:
multiple, non-keratinised warts - topical podophyllum
solitary, keratinised warts - cryotherapy
2nd line: imiquimod
14
Q
What is the treatment for HIV
A
Antiretroviral Therapy:
= At least 3 drugs
- Usually two nucleoside fever transcriptase inhibitors
+ either Protease inhibitor or a non-nucleoside reverse transcriptase inhibitor
ART should now commence AS SOON as they have been diagnosed with HIV
15
Q
how long can post-exposure prophylaxis for HIV be administered?
A
up to 72 hours post exposure
16
Q
What is the post exposure prophylaxis for Hep B
A
Known responder to HBV vaccine = A booster vaccine should be given
Non responder to HBV vaccine = A booster vaccine + Hepatitis B immunoglobulin
17
Q
what is the post exposure prophylaxis for hepatitis C
A
Monthly PCR - If seroconversion then: Interferon +/- ribavirin
18
Q
what is the post exposure prophylaxis for HIV
A
A combination of antiretrovirals ASAP (up to 72 hours) to be given FOR 4 WEEKS
Testing should be done 12 weeks after post exposure prophylaxis is finished
19
Q
when should HIV testing be done
A
If current infection - Can do one at presentation but MUST ALSO OFFER A REPEAT AFTER 12 WEEKS to confirm no infection.
If asymptomatic - You must wait 4 weeks. If this is negative, offer a repeat test at 12 weeks.
If combined test is positive, it should be repeated to confirm the diagnosis.
20
Q
what is tested in HIV testing
A
Combination tests are now standard = HIV P24 antigen and HIV antibody.
Antibodies - Most develop at 4-6 weeks but 99% will have by 3 months
and P24 antigen - usually positive between 1 - 3/4 weeks after infection
21
Q
what are the signs of HIV seroconversion
A
Symptomatic in 60-80% of patients:
Typically occurs 3-12 weeks after infection:
Sore throat
Lymphadenopathy
Malasia
Myalgia
Arthralgia
Diarrhoea
Maculopapular rash
Mouth Ulcers
22
Q
What blood levels indicate immunodeficiency in HIV
A
CD4+ T lymphocyte cell count <200/mm
Should be prescribed prophylactic antibiotics
23
Q
what antibiotics should be given in HIV
A
If CD4+ T lymphocyte could is <200/mm
Co-trimoxazole
As prophylaxis against pneumocystitis jirocevi pneumonia
24
Q
what are the signs of herpes simplex virus (genital herpes)
A
cold sores
painful genital ulceration
severe gingivostomatitis
25
who should be offered the hepatitis A vaccine
MSM
People travelling in areas of high prevalence if >1y/o
Patients with haemophilia
injecting drug users
Those with occupational risk
26
What is the rules regarding the tetanus vaccination?
5 doses of tetanus-containing vaccine are currently given as part of the routine UK vaccination schedule.
1. Patient has had full dose of tentanus vaccines with the last one <10 years ago = No vaccine or immunoglobulin is needed, PERIOD.
2. Patient has had full dose of tetanus vaccines with the last one >10 years:
- if tetanus wound prone - reinforcing dose of vaccine
- high-risk wound - reinforcing dose of vaccine + tetanus immunoglobulin
3. Vaccination history incomplete or unknown:
- Reinforcing dose of vaccine, regardless of wound severity
- Tetanus prone and high-risk wounds - reinforcing dose of vaccine + tetanus immunoglobulin
27
what is classed as a tetanus prone wound
- puncture type injuries acquired in a contaminated environment
- wound containing foreign bodies
- wounds or burns with systemic sepsis
- certain animal bites and scratches
28
What are high risk tetanus prone wounds
- heavy contamination with material likely to contain tetanus - soul, manure
- wounds or burns that show extensive revitalised tissue that require surgical intervention
29
what is tetanus
An infection caused by the bacteria clostridium tetani
30
what causes Lyme disease
borrelia burgdorferi
31
what are the causes of viral encephalitis
herpes simplex virus (most common)
varicella zoster virus
enterovirus
32
what is the treatment for tetanus
metronidazole
33
What are the symptoms of legionnaires disease?
flu like symptoms
fever
dry cough
bradycardia
confusion
lymphopaemia
hyponatraemia
deranged LFTs
Pleural effusion
34
how is legionella diagnosed?
urinary antigen
35
What is the treatment for legionella pheumophilia
erythromycin or clarythromycin
36
how is staphylococcus arranged under the microscope
Gram positive cocci
catalase positive
coagulase positive
37
How is pneumococcus described under the microscope
Gram positive diplococcus
38
what should a UTI in pregnancy be treated with
First line = Nitrofurantoin. UNLESS the woman is close to term (then give cefalexin)
Second line = Amoxicillin or cefalexin
Must treat symptomatic AND asymptomatic UTIs in pregnancy - as they can lead to pyelonephritis and premature delivery.
39
what should a UTI in pregnancy be treated with
First line = Nitrofurantoin. UNLESS the woman is close to term
Second line = Amoxicillin or cefalexin
7 day course
Must treat symptomatic AND asymptomatic UTIs in pregnancy - as they can lead to pyelonephritis and premature delivery.
40
how should catheterised patients with a UTI be treated
DONT treat asymptomatic bacteria in urine
Symptomatic bacteria in urine - 7 day course of antibiotics
41
what is the treatment for pneumocystitis jiroveci pneumonia
co-trimoxazole
42
which vaccines are live attenuated
- BCG
- MMR
- Intranasal influenza
- Oral rotavirus
- Oral polio
- Yellow fever
- Oral typhoid
43
What is the tuberculosis vaccine good and bad at?
Good - preventing TB meningitis and disseminated TB in children
Bad - Doesn't prevent primary infection or the reactivation of latent TB or pulmonary TB.
44
what is the treatment for suspected or confirmed Lyme disease
Doxycycline
Amoxicillin of doxycycline is contraindicated (pregnancy)
ceftriaxone if disseminated disease
45
what is the investigation for Lyme disease?
Diagnosed clinically if:
- Erythema migrans
First Line test:
- Enzyme linked immunosorbent assay antibodies (ELISA) to borrelia burgdorferi
46
what is the investigation for Lyme disease?
Diagnosed clinically if:
- Erythema migrans
First Line test:
- Enzyme linked immunosorbent assay antibodies (ELISA) to borrelia burgdorferi
If negative:
- in people tested within 4 weeks of symptom onset - repeat ELISA at 4-6 weeks after the first test
If negative but still suspected:
- If they have had symptoms for 12 weeks or more - Immunoblot test
47
what are the early and late signs of lyme
Early :
- erythema migrans (usually develops 1-4 weeks after initial bite, present in 80% of people, >5cm, usually painless)
- headache
- lethargy
- fever
- arthralgia
Later features:
- Heart block
- peri or myocarditis
- facial nerve palsy
radicular pain
meningitis
48
what causes chlamydia
chlamydia trachomatis
49
what are the features of chlamydia trachomatis
asymptomatic:
- 70% of women
- 50% of men
women - cervicitis, discharge, bleeding, dysuria
Men - urethral discharge, dysuria
50
what is the investigation for chlamydia
Nuclear acid amplification test (NAATs)
- women - vulvovaginal swab
- men - Urine test
done 2 weeks after possible exposure
51
what is the management of chlamydia
1st line:
- 7 days of doxycycline
- pregnancy - azithromycin, erythromycin or amoxicillin
52
what is the management of contacts of meningitis?
Oral ciprofloxacin or rifampicin
53
what are the features of hepatitis E
Spread faecal-orally (often in selfish or contaminated drinking water)
usually self-limiting and resolves within 2-4 weeks
Rare - fulminant hepatitis (acute liver failure)
54
which malignancies are associated with EBV
Bursitis lymphoma
Hodgkins lymphoma
Nasopharyngeal carcinoma
55
What is the first line antibiotic used to prophylactically treat animal bites (including humans)
Co-amoxiclav
If penicillin allergic - doxycycline or metronidazole
56
when are children offered the HPV vaccine
Girls AND boys - aged 12-13 years
57
what causes black hairy tongue
Tetracyclines: Doxycycline, tetracycline
58
when should a urine culture be sent regarding a UTI
Women:
- Pregnant
- Over 65
- Visible or non visible haematuria
- ALL Males
59
what I the most common bacteria found in central line infections
staphylococcus epidermitis
60
What is the management of syphilis
1st line: Intramuscular benzathine penicillin
Other: Doxycycline or ceftriaxone.
61
How is syphilis monitored to ensure treatment is working
Repeat serological tests:
- Non-treponemal plasma reagin (RPR)
- Venereal disease research laboratory test (VDRL)
*Titres should be monitored.
* A four fold titre decline in RPR is considered an adequate response to treatment
62
What causes syphilis
Bacteria - Treponema Pallidum
Sexually transmitted infection - oral, vaginal or anal sex.
Vertical transmission - From mother to baby during pregnancy.
IVDU
63
What is the incubation time of syphilis?
Time from infection to symptoms is around 21 days.
Can range form 9-90 days.
64
What is primary syphilis
Involves a primary ulcer (chancre) at the original site of infection. Usually the genitals.
Tends to resolve over 3-8 weeks.
Local non-tender lymphadenopathy.
65
What is secondary symptoms
Typically starts after the chancre has healed.
Involves the systemic symptoms (especially of the skin and mucous membranes).
These resolves after 3-12 weeks.
Maculopapular rash,
condylomata lata,
low grade fever,
lymphadenopathy,
alopecia,
oral lesions.
66
What is latent syphilis?
Occurs after the secondary stage.
The patient becomes asymptomatic DESPITE STILL BEING INFECTED.
Early latent syphilis - occurs within two years of the initial infection.
Late latent syphilis - occurs from two years after the initial infection.
67
What is tertiary syphilis?
Can occur many years after the initial infection.
Affects many organs of the body.
Gummatous lesions (granulomatous lesions that affect the skin, organs and bones).
Aortic aneurysm.
Neurosyphilis.
68
What is neurosyphilis?
Can occur AT ANY STAGE if the infection reaches the central nervous system.
Headache
altered behaviour
Dementia
Tabes dorsalis
Occular syphilis
Paralysis
Sensory impairment
*Argyll-Robertson pupil.
69
What is argyll robertson pupil
A constricted pupil that accommodates when focusing on a near object but DOES NOT REACT TO LIGHT.
Often irregularly shaped.
70
What is the test for syphilis?
Testing for Presence of T Pallidum:
- Dark field microscopy
- Polymerase chain reaction
71
What reaction can occur after treatment for syphilis?
Jarisch-Herxheimer reaction:
Fever
Rash
Tachycardia
After the first dose of antibiotics.
NO WHEEZE OR HYPOTENSION.
No treatment needed apart from antipyretics.
72
What are the features of typhoid?
Caused by salmonella Typhi
Normally presents within 21 days of return from travel
Systemic upset
Relative bradycardia
Abdominal pain, distention
Constipation
Rose spots
Diarrhoea
Fever
Headache
Pea green diarrhoea
73
What is the test for typhoid?
Blood cultures
Bone marrow aspiration - most sensitive
74
what are the causes of genital herpes?
Painful - HSV 1 and HSV 2
Painless - Treponema Pallidum
75
What are the signs of congenital syphilis?
Hutchinsons teeth - Blunted upper incisor teeth
Deafness
Saddle nose
Keratitis
Rhagades
76
What is the investigation for genital herpes?
Nucleic acid amplification test
77
What is the treatment for genital herpes?
Oral acyclovir
78
What causes malaria
Members of the plasmodium family.
75% is caused by plasmodium falciparum.
Spread through female mosquitoes.
Plasmodium:
- Falciparum (most severe).
- Vivax
- Ovale
- Malariae
79
What are the signs of malaria
Incubation is 1-4 weeks after infection:
- Fever
Sweats
Rigors
Malaise
Myalgia
Headache
Vomiting
Pallor (anaemia)
Jaundice (raised bilirubin)
Hepatosplenomegaly
80
What is the treatment of malaria
Falciparum:
- Admission to hospital
- Artemisinin-based combination (ACT)
Non-Falciparum:
- Artemisinin-based combination (ACT) OR Chloroquine
- Primaquine (following acute treatment) to prevent relapse
81
How is malaria diagnosed
Malaria blood film (in EDTA bottle)
3 samples sent over 3 consecutive days.
82
What test should be given to all patients with TB
HIV test
83
What is the treatment for latent TB
3 months - Of isonazid (with pyridoxine) and rifampicin
OR
6 months - Of isoniazid (with pyridoxine)
84
What is travellers diarrhoea?
Caused by E. coli.
Definition:
3 or more loose to watery stools in 24 hours with or without:
- Abdominal cramps
- Fever
- Nausea
- Vomiting
- blood in stool
85
What is the first line treatment for Lyme disease
14-21 day course of doxycycline.
Amoxicillin is an alternative
Ceftraixone if disseminated disease
Jarisch-Herxheimer reaction can be seen after initiating therapy.
86
What are the causes of pneumonia
CAP:
- Strep pneumonia = most common
- Staph aureus = following a flu infection
- Klebsiella pneumoniae = In alcoholics
87
What causes the common cold
Rhinovirus
88
What causes croup
Parainfluenza virus
89
What happens to the test results for syphyilis after treatment
Non-treponemal test (RPR):
Becomes negative after treatment
This is used to determine current disease activity
Treponemal test (TPHA):
Remains positive for life after infection
even after treatment
90
What lung complications may occur after infection of tuberculosis
An aspergilloma:
- A fungal mass found in pre-formed body cavities.
- They can occur in other diseases which causes cavities like sarcoidosis, bronchiectasis or ankylosing spondylitis
91
What is aspergilloma
A mycetoma (mass like fungus ball) which colonises an existing lung cavity.
92
What are the signs and symptoms of an aspergilloma
Usually asymptomatic
Dry cough or haemoptysis
Chest x-ray = Rounded opacity, crescent sign may be present.
93
What is the treatment for meningitis
IV Cefotaxime
+ Amoxicillin if >50 years or if <3 months
94
What is the most common cause of lactational mastitis
Staphylococcus aureus
95
What are the features of yellow fever
Sudden onset high fever, rigours, nausea and vomiting.
A brief remission followed by jaundice, haematemesis and oliguria.
96
What is Fitz-Hugh-Curtis syndrome
A complication of pelvic inflammatory disease where the liver capsule becomes inflamed and this causes right upper quadrant pain.
97
What causes Fitz-Hugh Curtis syndrome
Usually a previous infection of chlamydia or gonorrhoea
98
How is Fitz-Hugh Curtis syndrome treated
It is treated by eradicating the disease
Sometimes laparoscopy is needed if there has been adhesions formed
99
What should be done before beginning tuberculosis drugs
Visual acuity should be checked - Ethambutol can cause optic neuritis
100
What should be prescribed alongside Tuberculosis drugs
Pyridoxine (vitamin B6)
101
What is the most common cause of pyelonephritis
E. coli
102
What are the features of hepatitis A
Flu like symptoms
RUQ pain
Tender hepatomegaly
Derranged LFTs
85% make a full recovery within 3 months and almost all by 6 months
103
What is the management for EBV
Rest, plenty of fluid, avoid alcohol
Simple analgesia
Avoid contact sport for 4 weeks due to the risk of splenic rupture
104
what type of bacteria is neisseria meningitis
A gram negative diplococci
105
What type of bacteria is streptococcus pneumonia
Gram positive diplococchi/chain
106
What is the follow up treatment for pregnant women who have had a UTI
A further urine culture should always be sent following treatment as a test of cure
107
When is the Mantoux test considered to be positive
If erythema and induration is >10mm = implies previous exposure including BCG
108
What is the qSOFA score for sepsis
Respiratory rate >22
Altered mentation
Systolic blood pressure <100mmHg
>2 is an increased rate of mortality
109
What is the management of genital herpes during pregnancy
If its a primary infection during the third trimester - it should be managed with oral acyclovir until delivery and delivery should be done via a cesarean section.
If its a recurrent episode - women should be treated with suppressive therapy and advised that transmission to their baby is low
110
what is the cause of bacterial vaginosis
Gardnerella vaginalis
Microscopy - Clue cells
111
What is the treatment of bacterial vaginosis
Asymptomatic - treatment not needed
Symptomatic - Oral metronidazole for 5-7 days (topical metronidazole or topical clindamycin is an alternative)
Pregnancy - Oral metronidazole
112
What is the treatment for prostatitis
14 day course of ciprofloxacin
113
what is the treatment for sinusitis
< 10 days - no treatment
Other:
Steroid nasal sprays
Acute uncomplicated sinusitis:
- Phenoxymethylpenicillin
- penicillin allergy - doxycycline or clarithromycin
114
What are the most likely causes of oral and genital herpes
Oral - HSV 1
Genital - HSV 2
115
what should be offered to all patients with TB
A HIV test
116
how to tell the difference between viral and bacterial meningitis
Viral - the glucose will be over half the serum glucose level
Bacterial will be less than half
117
What is a common cause of chest infection in cystic fibrosis
Pseudomonas aeruginosa
118
What is the treatment for the different types of STI
Bacterial Vaginosis (Gardnerella Vaginalis) = Oral Metronidazole
Trichomonas Vaginalis = Oral Metronidazole
Gonorrhoea (Neisseria Gonorrhoea) = Oral Doxycycline
Oral thrush = Fluconazole
Vaginal Thrush (Candida albicans) =
Genital Herpes (HSV-1 and HSV-2) = Oral aciclovir
119
What is rabies
A viral disease that causes an acute encephalitis
120
What is the treatment for an animal bite in countries at risk of rabies
Wound washed
If already immunised - a further 2 doses of the vaccine should be given
If not already immunised - Human rabies immunoglobulin should be given + the vaccination
121
What is used as prophylaxis for contacts of patients with meningococcal meningitis
Given if they have been in contact with the patient within 7 days before onset of symptoms
Oral ciprofloxacin
OR
Oral rifampicin
122
Who should a urine dipstick not be used for diagnosis of a UTI in?
Women >65 years
Men
Catheterised patients
123
When does HIV seroconversion occur?
3-12 weeks post infection
Present in 60-80% of patients and presents as a glandular fever type illness.
Features:
sore throat
lymphadenopathy
malaise, myalgia, arthralgia
diarrhoea
maculopapular rash
mouth ulcers
rarely meningoencephalitis
124
What is the diagnosis of active tuberculosis
Chest x-ray
Sputum smear
Sputum culture - GOLD STANDARD
NAAT test
125
What is the diagnosis of latent TB
Mantoux test
Injected intradermally
Read 2-3 days later
126
What is primary tuberculosis
When a non-immune host is exposed to mycobacterium tuberculosis.
They develop a primary lung infection - a small lung lesion (Ghon Focus) develops.
In immunocompetent people - the lesion usually heals by fibrosis.
In immunocompromised individuals - they often develop disseminated disease (miliary tuberculosis) .
127
What is secondary tuberculosis
If a host becomes immunocompromised and the initial infection is reactivated.
Occurs most commonly in the apex of the lungs.
Can also occur in the CNS, vertebral bodies, lymph nodes, GI tract or renal.
Causes:
Immunosuppressive drugs
Steroids
HIV
Malnutrition
128
What type of bacteria is E. Coli
An aerobic gram-negative rod
129
What common bacterias are gram positive cocci
Staphylococci
Streptococci
130
What common bacteria are gram negative cocci
Neisseria meningitides
Neisseria gonorrhoea
Moraxella catarrhalis
131
What are the common gram negative rods
E. Coli
Haemophilus influenzae
Shigella
Salmonella
Pseudomonas aeruginosa
Campylobacter jejuni
132
What is the investigations for cellulitis
The diagnosis is clinical
133
What is the most common cause of an infective exacerbation of COPD
Haemophilus Influenza
134
who should a urine culture be sent for
Non-pregnant women:
- >65 years
- Visible or non-visible haematuria
Pregnant women:
- All pregnant women
- A further urine culture should be sent following completion of treatment as a test of cure
135
who should a urine culture be sent for
Non-pregnant women:
- >65 years
- Visible or non-visible haematuria
Pregnant women:
- All pregnant women
- A further urine culture should be sent following completion of treatment as a test of cure
Men:
- All men
136
what is the treatment of acute pyelonephritis
broad spectrum cephalosporin or quinolone (for non pregnant women) for 10-14 days
137
What are the features of legionnaires pneumoniae
Hyponatraemia
Infected water - cheap hotel holiday
Diagnosed by urinary antigen
Treated with erythromycin or clarithromycin
138
What is the cause of necrotising fasciitis
Type 1 - Mixed anaerobes and aerobes (occurs post surgery in diabetics) this is most common.
Type 1 - Streptococcus pyogenes
139
What is the management of necrotising fasciitis
Urgent surgical referral debridement
IV antibiotics
