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Medical School Finals > Speciality: Infectious Diseases > Flashcards

Speciality: Infectious Diseases Flashcards

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USMLE® Step 1 flashcards
1
Q

Patient - just returned from Africa, Erratic fever (41) w/ rigors and sweats, N&V, headache, diarrhoea, developing shock. Dark urine and reducing GCS. Anaemia.

A

Malaria

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2
Q

Malaria Aetiology

A
  • Protozoal infection.
  • Female anopheles mosquito
  • Plasmodium falciparum, vivax, ovale, malariae.
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3
Q

Malaria pathology

A
  • Female mosquito is infected and there is a growth cycle within the insects gut (temperature sensitive, denoting disease distribution)
  • Innoculates human host
  • Protazoa taken up by hepatocytes.
  • Affects RBC’s
  • Most effects relating to anaemia, cytokine release, organ damage and failure.
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4
Q

Malaria Presentation

A
  • Normal incubation period = 10-21 days.
  • Fever (erratic and high)
  • Rigors and sweats
  • Malaise
  • Headache
  • N&V
  • Diarrhoea

Vivax and ovale = more mild disease with emerging anaemia and self-limiting prognosis resolving in 2-6 weeks.
Falciparum = Can be severe w/ cerebral malaria, blackwater fever, DIC, ARDS and shock.

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5
Q

Malaria Ix

A

1) Clinical - anyone unwell after travelling to endemic area.
2) Giemsa (thick and thin) blood film - 3x films before Dx.
3) Try to confirm Dx prior to Rx.
4) Rapid antigen testing is available in some places

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6
Q

Malaria Rx

A

1) ABCDE
2) Uncomplicated = Chloroquinine (PV, PO, PM are sensitive) following Rx with chloroquine, a further 3 weeks of primaquine is required to prevent hepatic release of more protozoa.
3) Falciparum = Artemisinin based combo therapy.
4) Severe or complicated PF disease is a medical emergency. ITU. IV artesunate.

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7
Q

Malaria prophylaxis

A
  • Malarone, doxycyline, chloroquine

- Measures of insect avoidance

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8
Q

Patient - Middle eastern, Middle aged just been commenced on immunosuppression therapy for RA (MTX), productive cough w/ heamoptysis, drenching night sweats, fevers, weight loss.

A
  • TB
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9
Q

TB Aetiology

A
  • Mycobacterium TB, Bovis or africanum.
  • Acid-fast bacilli
  • RF’s = T2DM, HIV, STEROIDS, immunosuppression, alcohol, sex, homelessness, cramped housing.
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10
Q

TB Pathology

A
  • Associated with poor housing and ventilation and over-crowding due to being droplet spread.
  • Often Primary infection is asymptomatic and causes only a mild illness.
  • Alveolar macrophages eat the pathogen and release chemicals causing inflammation - necrosis and caseating granuloma.
  • Often is reactivated when immunosuppressed etc.
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11
Q

TB Presentation

A
  • Pulmonary TB - Productive cough w/ haemoptysis, sweats, fever etc.
  • Nodal TB - normally extrathoracic, firm and non-tender nodes.
  • Miliary TB - multiple organ sites including CNS w/ microabscesses.
  • GU TB - dysuria, frequency, loin pain, bladder and testicles.
  • Bone TB - Vertebral collapse, potts vertebra.
  • Skin TB - lupus vulgaris, jelly lesions on the face and neck.
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12
Q

TB Ix

A

1) CXR - consolidation, effusion, calcification and hilar node lymphadenopathy.
2. Sputum MC&S

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13
Q

TB Rx

A

1) HERZ ABx for 2 months followed by rifampicin + isoniazid for 4 months.
2) DOTS therapy.

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14
Q

MRSA infection management

A
  1. Vancomycin or teicoplanin
  2. Linezolid
  3. Ciprofloxacin
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15
Q

Sepsis 6

A
  1. Oxygen
  2. Blood cultures
  3. Abx
  4. Fluids
  5. Serum lactate - ABG/VBG
  6. Catheter
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16
Q

Bacterial vaginosis

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Overgrowth of vaginal flora
    - Gardnerella vaginalis
    - Fall in lactic acid producing lactobacilli resulting in raised pH.
  2. Vaginal discharge; fishy
    - Often asymptomatic.
  3. Swab of discharge
    - Clinical
    - Whiff test - potassium hydroxide to the discharge = fishy.
  4. Oral metronidazole 5-7days
17
Q

Cellulitis

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Inflammation of skin and SC tissues.
    - Strep pyogenes
    - Staph aureus
  2. Erythema
    - Pain
    - swelling
    - Often on shins
    - May be systemic upset.
  3. Clinical
    - Blood cultures
    - Bloods for raised inflammation markers and WCC
  4. Oral flucloxacillin or (clarithromycin)
    - If severe admit for IV augementin, cefuroxime etc –> severe Sx, systemic upset, nec fasc.
18
Q

Gonorrhoea

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. STI
    - Neisseria Gonorrhoeae
    - Acute infection of the GU tract or the rectum and pharynx.
  2. Incubation = 2-5 days
    - Males - urethral discharge, dysuria
    - Females - cervicitis, vaginal discharge
  3. High vaginal swabs
    - Mid stream urine.
  4. IM ceftriaxone 1g
    - Or IM ceftriaxone + oral azithromycin.
    - Oral cefixime 400mg + oral azithromycin 2g.
19
Q

Legionella

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Legionella pneumophilia.
    - Colonises water tanks … AC units
    - ‘Patient just returned home from spain …’
  2. Flu like Sx
    - Dry cough
    - bradycardia
    - Confusion
    - Lymphopenia
    - Hyponatraemia
    - Deranged LFT
    - Pleural effusions.
  3. CXR
    - Urinary antigen testing.
  4. Erythromycin/clarithromycin.
20
Q

Invasive diarrhoea (bloody diarrhoea and fever) management

A
  • Often nil

- If severe clarithromycin.

21
Q

Kaposi Sarcoma

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. HHV-8
    - HIV or severely immunosuppressed
    - AIDS defining illness.
    - Neoplasm of skin.
  2. Skin lesions; nodular, popular or blotchy. May be red, purple, brown or black.
    - See on or under mucus membranes
    - Painless but can be inflamed or swollen.
  3. Detection of latency associated nuclear antigen.
  4. Incurable.
    - Rx underlying cause
    - HAART will often reduce lesions.
    - Radio/cryo/surgery.
    - Systemic chemo is organ involvement.
22
Q

Hepatitis B

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Double stranded DNA virus.
    - spread via blood and bodily fluids.
    - Vertical transmission.
  2. Incubation = 6-20 weeks.
    - Fever
    - Jaundice
    - LFT derangement
    - Chronic hepatitis
    - Liver failure
    - HCC
  3. Viral markers and viral load.
    - HBsAG
    - Anti-HBV IgM is diagnostic (acute phase)
    - PCR of HBV DNA
    - Test for HIV too.
  4. Mainly asymptomatic
    - Pegylated interferon alpha
    - Tenofovir etc.
    - treat Sx
23
Q

HBV immunisation

A
  • children in the UK at 2,3 and 4mo.
  • At risk groups.
  • Vaccination contains HBsAg
  • Good response = >100 Anti-HBs - booster at 5 years.
  • Suboptimal response = 10-100 - one additional vaccine.
  • Non-responder = <10 - test for current or past infection. Further vaccine course. May require HBIG.
24
Q 
Viral haemorrhagic fever 
1. Causes 
2. Presentation 
3, Ix 
4. Rx
A
  1. Filoviridae virus
    - Human to human transmission via blood.
  2. Incubation = 2-21 days
    - Patients are not infectious until they develop Sx.
    - Sudden onset fever, fatigue, muscle pain, headache and sore throat.
    - Vomiting, diarrhoea, rash, internal and external bleeding.
  3. PHE
  4. PHE
25
Q

Lyme disease

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Spirochete Borrelia Burgdorferi
    - Spread via tics
  2. Bulls-eye rash
    - Systemic features of fever and arthralgia.
    - Heart block and myocarditis
    - Facial nerve palsy
    - Meningitis
  3. Clinically Dx if bulls-eye rash is seen
    - ELISA of borrelia
  4. Doxycycline if early disease.
    - Ceftriaxone if disseminated disease.
26
Q

Rifampicin

  1. MOA
  2. SE
A
  1. CYP450 inducer

2. Can stain secretions such as sweat and urine red

27
Q

Isoniazid

  1. MOA
  2. SE
A
  1. CYP450 inhibitor
  2. Drug induced lupus and peripheral neuropathy.
    - Pyridoxine (vit B6) is given to prevent this
28
Q

Streptomycin

  1. MOA
  2. SE
A
  1. Aminoglycoside

2. Toxic to ears and kidneys

29
Q

Ethambutol

  1. MOA
  2. SE
A
  1. Prevents growth of TB

2. Eyesight problems; colour blindness and poor vision.

30
Q

Genital warts

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. HPV 6 & 11
    - 16 & 18 predispose to Ca.
  2. Small fleshy warts which may itch or bleed.
  3. Clinical
    - Swab and MC&S
  4. Topical cryotherapy are first line depending on site.
    - Imiquimod cream.
31
Q

Syphilis organism

A

Treponema pallidum

32
Q

Genital herpes

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Causes HSV2 (HSV1)
  2. Primary infection - severe ulceration and pain
    - Urinary retention
    - Painful recurrent ulceration.
  3. Clinical
    - Swab and MC&S
  4. Oral acyclovir
    - Section if pregnant and herpes is present.
33
Q

Post exposure prophylaxis

A

Hep A - vaccine or Human normal immunoglobin can be used.

Hep B - If the exposed person is a responder to the vaccine, booster should be given.
- Non-vaccinated HBIG + vaccine.

Hep C - monthly PCR, if seroconverting interferon + ribavirin.

HIV - Combo of oral antiretroviral (tenofovir etc) ASAP for 4 weeks, but can be started up to 72hrs post.

34
Q

Infectious mononucleosis

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. EBV
    - others include, CMV and HHV-6.
  2. Sore throat + pyrexia + lymphadenopathy.
    - Other include; malaise, palatal petechiae, HSM, haemolytic anaemia.
    - Maculopapular rash when taken amoxicillin.
    - Resolves in 2-4 weeks.
  3. Monospot test (heterophuil antibody test)
  4. Rest + drinks + avoid alcohol
    - Simple analgesia
35
Q

Hepatitis E

A
  • FO route
  • Undercooked pork and shellfish
  • 3-8 weeks incubation
  • Carries significant mortality in pregnancy.
  • Self-resolving.
36
Q

MRSA

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Methicillin resistant SA
    - screen all those waiting for elective admission (except, TOP, ophthalmic surgery)
    - Nasal swab and lesion swab.
  2. Suppression of MRSA w/ nasal mupirocin 2% in paraffin TDS 5 days + chlorhexidine wash for 5 days.
    - ABx used = vancomycin, teicoplanin and linezolid.
37
Q

Meningitis causes by age group

0-3mo
3mo-6yo
6-60yo
>60yo

A
  • GBS, E.coli and listeria
  • Neisseria meningitidis, S.pneumoniae, Haemophilus
  • Meningococcus, S.pneumoniae
  • S.pneumoniae, meningococcus and listeria
38
Q

Pneumocystis Jiroveci Pneumonia

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Fungus - Pneumocystis jiroveci
    - Aids defining illness
    - CD4 count less than 200 should receive prophylaxis.
  2. SOB
    - Dry cough
    - Desaturation of exertion
    - Pneumothorax
    - HSM
  3. CXR - BL interstitial infiltrates.
    - Sputum fails to show PCP
    - BAL (silver stain)
  4. Co-trimoxazole
    - IV pentamidine in sever cases.
    - Steroids if hypoxic.

Medical School Finals (24 decks)

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