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Exam - M - Infection (Megan) > Passmedicine > Flashcards

Passmedicine Flashcards

1
Q

What antibiotics are used to treat MRSA?

A

1st line = vancomycin or teicoplanin.

2nd line = Linezolid

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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

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3
Q

What is the treatment for trichomonas vaginalis

A

Oral metronidazole

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4
Q

What is the treatment for gonorrhoea

A

gram negative diplococcus - Neisseria Gonorrhoea:
- IM Ceftriaxone

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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

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6
Q

What is giardiasis

A

Caused by Giardia lamblia

Spread by faecal oral route

Treated with metronidazole

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7
Q

What causes cellulitis

A

Most common = Streptococcus pyogenes

Other = Staphylococcus aureus

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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

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9
Q

What is a sign of EBV?

A

Lymphadenopathy
Pyrexia
Sore throat

Maculopapular pruritic rash in patients who take amoxicillin

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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

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11
Q

what are the signs of trichomonad vaginalis

A

Vaginal discharge: Offensive, yellow/green, frothy
pH >4.5
Strawberry cervix
Vulvovaginitis

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12
Q

what are genital warts

A

Caused by the HPV virus - Especially types 6 and 11.

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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

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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

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15
Q

how long can post-exposure prophylaxis for HIV be administered?

A

up to 72 hours post exposure

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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

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17
Q

what is the post exposure prophylaxis for hepatitis C

A

Monthly PCR - If seroconversion then: Interferon +/- ribavirin

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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

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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.

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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

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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

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22
Q

What blood levels indicate immunodeficiency in HIV

A

CD4+ T lymphocyte cell count <200/mm

Should be prescribed prophylactic antibiotics

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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

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24
Q

what are the signs of herpes simplex virus (genital herpes)

A

cold sores
painful genital ulceration
severe gingivostomatitis

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25
Q

who should be offered the hepatitis A vaccine

A

MSM
People travelling in areas of high prevalence if >1y/o
Patients with haemophilia
injecting drug users
Those with occupational risk

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26
Q

What is the rules regarding the tetanus vaccination?

A

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
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27
Q

what is classed as a tetanus prone wound

A
  • puncture type injuries acquired in a contaminated environment
  • wound containing foreign bodies
  • wounds or burns with systemic sepsis
  • certain animal bites and scratches
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28
Q

What are high risk tetanus prone wounds

A
  • heavy contamination with material likely to contain tetanus - soul, manure
  • wounds or burns that show extensive revitalised tissue that require surgical intervention
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29
Q

what is tetanus

A

An infection caused by the bacteria clostridium tetani

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30
Q

what causes Lyme disease

A

borrelia burgdorferi

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31
Q

what are the causes of viral encephalitis

A

herpes simplex virus (most common)

varicella zoster virus

enterovirus

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32
Q

what is the treatment for tetanus

A

metronidazole

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33
Q

What are the symptoms of legionnaires disease?

A

flu like symptoms
fever
dry cough
bradycardia
confusion
lymphopaemia
hyponatraemia
deranged LFTs
Pleural effusion

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34
Q

how is legionella diagnosed?

A

urinary antigen

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35
Q

What is the treatment for legionella pheumophilia

A

erythromycin or clarythromycin

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36
Q

how is staphylococcus arranged under the microscope

A

Gram positive cocci
catalase positive
coagulase positive

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37
Q

How is pneumococcus described under the microscope

A

Gram positive diplococcus

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38
Q

what should a UTI in pregnancy be treated with

A

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.

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39
Q

what should a UTI in pregnancy be treated with

A

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.

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40
Q

how should catheterised patients with a UTI be treated

A

DONT treat asymptomatic bacteria in urine

Symptomatic bacteria in urine - 7 day course of antibiotics

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41
Q

what is the treatment for pneumocystitis jiroveci pneumonia

A

co-trimoxazole

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42
Q

which vaccines are live attenuated

A
  • BCG
  • MMR
  • Intranasal influenza
  • Oral rotavirus
  • Oral polio
  • Yellow fever
  • Oral typhoid
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43
Q

What is the tuberculosis vaccine good and bad at?

A

Good - preventing TB meningitis and disseminated TB in children

Bad - Doesn’t prevent primary infection or the reactivation of latent TB or pulmonary TB.

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44
Q

what is the treatment for suspected or confirmed Lyme disease

A

Doxycycline

Amoxicillin of doxycycline is contraindicated (pregnancy)

ceftriaxone if disseminated disease

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45
Q

what is the investigation for Lyme disease?

A

Diagnosed clinically if:
- Erythema migrans

First Line test:
- Enzyme linked immunosorbent assay antibodies (ELISA) to borrelia burgdorferi

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46
Q

what is the investigation for Lyme disease?

A

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

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47
Q

what are the early and late signs of lyme

A

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

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48
Q

what causes chlamydia

A

chlamydia trachomatis

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49
Q

what are the features of chlamydia trachomatis

A

asymptomatic:
- 70% of women
- 50% of men

women - cervicitis, discharge, bleeding, dysuria

Men - urethral discharge, dysuria

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50
Q

what is the investigation for chlamydia

A

Nuclear acid amplification test (NAATs)

  • women - vulvovaginal swab
  • men - Urine test

done 2 weeks after possible exposure

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51
Q

what is the management of chlamydia

A

1st line:
- 7 days of doxycycline
- pregnancy - azithromycin, erythromycin or amoxicillin

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52
Q

what is the management of contacts of meningitis?

A

Oral ciprofloxacin or rifampicin

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53
Q

what are the features of hepatitis E

A

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)

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54
Q

which malignancies are associated with EBV

A

Bursitis lymphoma
Hodgkins lymphoma
Nasopharyngeal carcinoma

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55
Q

What is the first line antibiotic used to prophylactically treat animal bites (including humans)

A

Co-amoxiclav

If penicillin allergic - doxycycline or metronidazole

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56
Q

when are children offered the HPV vaccine

A

Girls AND boys - aged 12-13 years

57
Q

what causes black hairy tongue

A

Tetracyclines: Doxycycline, tetracycline

58
Q

when should a urine culture be sent regarding a UTI

A

Women:
- Pregnant
- Over 65
- Visible or non visible haematuria
- ALL Males

59
Q

what I the most common bacteria found in central line infections

A

staphylococcus epidermitis

60
Q

What is the management of syphilis

A

1st line: Intramuscular benzathine penicillin

Other: Doxycycline or ceftriaxone.

61
Q

How is syphilis monitored to ensure treatment is working

A

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
Q

What causes syphilis

A

Bacteria - Treponema Pallidum

Sexually transmitted infection - oral, vaginal or anal sex.

Vertical transmission - From mother to baby during pregnancy.

IVDU

63
Q

What is the incubation time of syphilis?

A

Time from infection to symptoms is around 21 days.

Can range form 9-90 days.

64
Q

What is primary syphilis

A

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
Q

What is secondary symptoms

A

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
Q

What is latent syphilis?

A

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
Q

What is tertiary syphilis?

A

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
Q

What is neurosyphilis?

A

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
Q

What is argyll robertson pupil

A

A constricted pupil that accommodates when focusing on a near object but DOES NOT REACT TO LIGHT.

Often irregularly shaped.

70
Q

What is the test for syphilis?

A

Testing for Presence of T Pallidum:
- Dark field microscopy
- Polymerase chain reaction

71
Q

What reaction can occur after treatment for syphilis?

A

Jarisch-Herxheimer reaction:
Fever
Rash
Tachycardia

After the first dose of antibiotics.
NO WHEEZE OR HYPOTENSION.

No treatment needed apart from antipyretics.

72
Q

What are the features of typhoid?

A

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
Q

What is the test for typhoid?

A

Blood cultures

Bone marrow aspiration - most sensitive

74
Q

what are the causes of genital herpes?

A

Painful - HSV 1 and HSV 2

Painless - Treponema Pallidum

75
Q

What are the signs of congenital syphilis?

A

Hutchinsons teeth - Blunted upper incisor teeth
Deafness
Saddle nose
Keratitis
Rhagades

76
Q

What is the investigation for genital herpes?

A

Nucleic acid amplification test

77
Q

What is the treatment for genital herpes?

A

Oral acyclovir

78
Q

What causes malaria

A

Members of the plasmodium family.

75% is caused by plasmodium falciparum.

Spread through female mosquitoes.

Plasmodium:
- Falciparum (most severe).
- Vivax
- Ovale
- Malariae

79
Q

What are the signs of malaria

A

Incubation is 1-4 weeks after infection:
- Fever
Sweats
Rigors
Malaise
Myalgia
Headache
Vomiting
Pallor (anaemia)
Jaundice (raised bilirubin)
Hepatosplenomegaly

80
Q

What is the treatment of malaria

A

Falciparum:
- Admission to hospital
- Artemisinin-based combination (ACT)

Non-Falciparum:
- Artemisinin-based combination (ACT) OR Chloroquine
- Primaquine (following acute treatment) to prevent relapse

81
Q

How is malaria diagnosed

A

Malaria blood film (in EDTA bottle)

3 samples sent over 3 consecutive days.

82
Q

What test should be given to all patients with TB

A

HIV test

83
Q

What is the treatment for latent TB

A

3 months - Of isonazid (with pyridoxine) and rifampicin

OR

6 months - Of isoniazid (with pyridoxine)

84
Q

What is travellers diarrhoea?

A

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
Q

What is the first line treatment for Lyme disease

A

14-21 day course of doxycycline.

Amoxicillin is an alternative

Ceftraixone if disseminated disease

Jarisch-Herxheimer reaction can be seen after initiating therapy.

86
Q

What are the causes of pneumonia

A

CAP:
- Strep pneumonia = most common
- Staph aureus = following a flu infection
- Klebsiella pneumoniae = In alcoholics

87
Q

What causes the common cold

A

Rhinovirus

88
Q

What causes croup

A

Parainfluenza virus

89
Q

What happens to the test results for syphyilis after treatment

A

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
Q

What lung complications may occur after infection of tuberculosis

A

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
Q

What is aspergilloma

A

A mycetoma (mass like fungus ball) which colonises an existing lung cavity.

92
Q

What are the signs and symptoms of an aspergilloma

A

Usually asymptomatic

Dry cough or haemoptysis

Chest x-ray = Rounded opacity, crescent sign may be present.

93
Q

What is the treatment for meningitis

A

IV Cefotaxime

+ Amoxicillin if >50 years or if <3 months

94
Q

What is the most common cause of lactational mastitis

A

Staphylococcus aureus

95
Q

What are the features of yellow fever

A

Sudden onset high fever, rigours, nausea and vomiting.

A brief remission followed by jaundice, haematemesis and oliguria.

96
Q

What is Fitz-Hugh-Curtis syndrome

A

A complication of pelvic inflammatory disease where the liver capsule becomes inflamed and this causes right upper quadrant pain.

97
Q

What causes Fitz-Hugh Curtis syndrome

A

Usually a previous infection of chlamydia or gonorrhoea

98
Q

How is Fitz-Hugh Curtis syndrome treated

A

It is treated by eradicating the disease
Sometimes laparoscopy is needed if there has been adhesions formed

99
Q

What should be done before beginning tuberculosis drugs

A

Visual acuity should be checked - Ethambutol can cause optic neuritis

100
Q

What should be prescribed alongside Tuberculosis drugs

A

Pyridoxine (vitamin B6)

101
Q

What is the most common cause of pyelonephritis

A

E. coli

102
Q

What are the features of hepatitis A

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
Q

What is the management for EBV

A

Rest, plenty of fluid, avoid alcohol
Simple analgesia
Avoid contact sport for 4 weeks due to the risk of splenic rupture

104
Q

what type of bacteria is neisseria meningitis

A

A gram negative diplococci

105
Q

What type of bacteria is streptococcus pneumonia

A

Gram positive diplococchi/chain

106
Q

What is the follow up treatment for pregnant women who have had a UTI

A

A further urine culture should always be sent following treatment as a test of cure

107
Q

When is the Mantoux test considered to be positive

A

If erythema and induration is >10mm = implies previous exposure including BCG

108
Q

What is the qSOFA score for sepsis

A

Respiratory rate >22
Altered mentation
Systolic blood pressure <100mmHg

> 2 is an increased rate of mortality

109
Q

What is the management of genital herpes during pregnancy

A

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
Q

what is the cause of bacterial vaginosis

A

Gardnerella vaginalis

Microscopy - Clue cells

111
Q

What is the treatment of bacterial vaginosis

A

Asymptomatic - treatment not needed

Symptomatic - Oral metronidazole for 5-7 days (topical metronidazole or topical clindamycin is an alternative)

Pregnancy - Oral metronidazole

112
Q

What is the treatment for prostatitis

A

14 day course of ciprofloxacin

113
Q

what is the treatment for sinusitis

A

< 10 days - no treatment

Other:
Steroid nasal sprays

Acute uncomplicated sinusitis:
- Phenoxymethylpenicillin
- penicillin allergy - doxycycline or clarithromycin

114
Q

What are the most likely causes of oral and genital herpes

A

Oral - HSV 1
Genital - HSV 2

115
Q

what should be offered to all patients with TB

A

A HIV test

116
Q

how to tell the difference between viral and bacterial meningitis

A

Viral - the glucose will be over half the serum glucose level
Bacterial will be less than half

117
Q

What is a common cause of chest infection in cystic fibrosis

A

Pseudomonas aeruginosa

118
Q

What is the treatment for the different types of STI

A

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
Q

What is rabies

A

A viral disease that causes an acute encephalitis

120
Q

What is the treatment for an animal bite in countries at risk of rabies

A

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
Q

What is used as prophylaxis for contacts of patients with meningococcal meningitis

A

Given if they have been in contact with the patient within 7 days before onset of symptoms

Oral ciprofloxacin

OR

Oral rifampicin

122
Q

Who should a urine dipstick not be used for diagnosis of a UTI in?

A

Women >65 years
Men
Catheterised patients

123
Q

When does HIV seroconversion occur?

A

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
Q

What is the diagnosis of active tuberculosis

A

Chest x-ray

Sputum smear

Sputum culture - GOLD STANDARD

NAAT test

125
Q

What is the diagnosis of latent TB

A

Mantoux test
Injected intradermally
Read 2-3 days later

126
Q

What is primary tuberculosis

A

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
Q

What is secondary tuberculosis

A

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
Q

What type of bacteria is E. Coli

A

An aerobic gram-negative rod

129
Q

What common bacterias are gram positive cocci

A

Staphylococci
Streptococci

130
Q

What common bacteria are gram negative cocci

A

Neisseria meningitides
Neisseria gonorrhoea
Moraxella catarrhalis

131
Q

What are the common gram negative rods

A

E. Coli
Haemophilus influenzae
Shigella
Salmonella
Pseudomonas aeruginosa
Campylobacter jejuni

132
Q

What is the investigations for cellulitis

A

The diagnosis is clinical

133
Q

What is the most common cause of an infective exacerbation of COPD

A

Haemophilus Influenza

134
Q

who should a urine culture be sent for

A

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
Q

who should a urine culture be sent for

A

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
Q

what is the treatment of acute pyelonephritis

A

broad spectrum cephalosporin or quinolone (for non pregnant women) for 10-14 days

137
Q

What are the features of legionnaires pneumoniae

A

Hyponatraemia
Infected water - cheap hotel holiday
Diagnosed by urinary antigen

Treated with erythromycin or clarithromycin

138
Q

What is the cause of necrotising fasciitis

A

Type 1 - Mixed anaerobes and aerobes (occurs post surgery in diabetics) this is most common.

Type 1 - Streptococcus pyogenes

139
Q

What is the management of necrotising fasciitis

A

Urgent surgical referral debridement
IV antibiotics

Exam - M - Infection (Megan) (8 decks)

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