Tropical Medicine 1 Flashcards
- The following are recognised causes of eosinophilia
a. malaria
b. visceral leishmaniasis
c. Churg-Strauss syndrome
d. drug hypersensitivity
e. visceral larva migrans (toxocariasis)
False a. malaria False b. visceral leishmaniasis True c. Churg-Strauss syndrome True d. drug hypersensitivity True e. visceral larva migrans (toxocariasis)
what are important parasitic causes of eosinophilia?
Filarial worms Tapeworms Strongyloidiasis Hydatid disease Hookworm Fascioliasis Toxocariasis (visceral larva migrans) Schistosomiasis Trichinella spiralis Intestinal nematodes Tropical pulmonary eosinophilia (usually results from hypersensitivity to microfilariae)
what are important non-parasitic causes of eosinophilia?
Allergic disorders - Asthma Eczema Hayfever Drug hypersensitivity
Auto-immune -
Churg-Strauss syndrome
Wegener’s granulomatosis
Polyarteritis nodosa
Haematological -
Hodgkin’s disease
Eosinophilic leukaemia
Dermatological -
Bullous pemphigoid
Pemphigus vulgaris
Respiratory -
Allergic bronchopulmonary aspergillosis
Hypereosinophilic syndrome
Asthma
Miscellaneous -
Eosinophilia-myalgia syndrome caused by L-Tryptophan
Spanish toxic oil syndrome
Eosinophilic gastroenteritis
- Giardia lamblia
a. is usually acquired by ingestion of food or water contaminated by the trophozoites
b. trophozoites have four flagella
c. can effectively be treated by mepacrine
d. cysts are killed by standard chlorination of water
e. cysts survive in water boiled for ten minutes
False a. is usually acquired by ingestion of food or water contaminated by the trophozoites (ingestion of cysts)
False b. trophozoites have four flagella (have four pairs of flagella)
True c. can effectively be treated by mepacrine. Metronidazole more commonly used now
False d. cysts are killed by standard chlorination of water
False e. cysts survive in water boiled for ten minutes
What is life cycle of Giradia?
During the trophozoite phase it lives in the proximal small bowel where it adheres to the mucosa. Each trophozoite has four pairs of flagella.
Infection is acquired though water contaminated with giardial cysts.
- Mosquitoes are the vector in the following disorders
a. onchocerciasis
b. visceral leishmaniasis
c. myiasis
d. African trypanosomiasis
e. Bancroftian filariasis
False a. onchocerciasis False b. visceral leishmaniasis False c. myiasis False d. African trypanosomiasis True e. Bancroftian filariasis
What is vector for these diseases?
Onchocerciasis
Loa Loa
leishmaniasis
African Trypanosomiasis
South American Trypanosomiasis
Bancroftian filariasis
Myiasis
Onchocerciasis - similium fly
Loa loa - Chrysops
leishmaniasis - sandfly
African Trypanosomiasis - Tsetse
South American Trypanosomiasis - Reduviid bug
Bancroftian filariasis - various mosquitoes
Myiasis - tumbu fly
- Consumption of raw fish or shellfish is associated with infection caused by
a. Clonorchis sinensis
b. Ancylostoma duodenale
c. Schistosoma japonicum
d. Vibrio parahaemolyticus
e. Paragonimus westermani
True a. Clonorchis sinensis False b. Ancylostoma duodenale False c. Schistosoma japonicum True d. Vibrio parahaemolyticus False e. Paragonimus westermani
A. duodenale and S. japonicum both gain entry via penetration of intact skin by immature forms.
Other infectious diseases associated with shellfish / raw fish include hepatitis A and gnathostomiasis.
- Following splenectomy for trauma
a. thrombocytopaenia is typical
b. pneumococcal vaccine should be given
c. malaria is more severe
d. prophylactic penicillin should be taken for six weeks
e. Heinz bodies are characteristically seen on the blood film
False a. thrombocytopaenia is typical
True b. pneumococcal vaccine should be given
True c. malaria is more severe
False d. prophylactic penicillin should be taken for six weeks
False e. Heinz bodies are characteristically seen on the blood film
Splenectomy typically results in thrombocytosis.
Howell-Jolly bodies are small pieces of nuclear material usually removed from erythrocytes by the spleen.
Heinz bodies are oxidised, denatured bits of haemoglobin found in G-6-PD deficiency for example. Special stains are required to see Heinz bodies.
- Nephrotic syndrome is a recognised complication of infection with
a. Schistosoma mansoni
b. Plasmodium malariae
c. Hepatitis B virus
d. Mycobacterium leprae
e. Loa loa
True a. Schistosoma mansoni True b. Plasmodium malariae True c. Hepatitis B virus True d. Mycobacterium leprae True e. Loa loa
- HIV positive patients may receive
a. measles vaccine
b. TY21a (oral typhoid vaccine)
c. Hib vaccine
d. BCG
e. Havrix (hepatitis A vaccine)
True a. measles vaccine False b. TY21a (oral typhoid vaccine) True c. Hib vaccine False d. BCG True e. Havrix (hepatitis A vaccine
BCG contraindicated at all CD4 counts
Most other live vaccines ok if CD4 >200
- Steroids are of benefit in the treatment of
a. visceral leishmaniasis
b. Eschericia coli septicaemia
c. cerebral malaria
d. severe typhoid fever
e. herpes zoster recrudescence (shingles)
False a. visceral leishmaniasis False b. Eschericia coli septicaemia False c. cerebral malaria True d. severe typhoid fever??? False e. herpes zoster recrudescence (shingles)
Steroids beneficial: Severe typhoid Hib meningitis in children Croup Tuberculoid leprosy Severe pneumocystis pneumonia Tuberculous meningitis Tuberculous pericarditis Tuberculous pleural effusion Type 1 lepra reaction Katayama fever
- In tuberculoid leprosy
a. peripheral nerves are involved symmetrically
b. the lepromin test is positive
c. hair growth is normal in affected skin lesions
d. smear negative cases can be treated with steroids alone
e. skin lesions usually have a well-demarcated, raised edge
a. peripheral nerves are involved symmetrically
True b. the lepromin test is positive
c. hair growth is normal in affected skin lesions
d. smear negative cases can be treated with steroids alone
True e. skin lesions usually have a well-demarcated, raised edge
Peripheral nerves may be thickened but are characteristically involved asymmetrically.
There are typically only 1 or 2 skin lesions which are well-demarcated, dry, scaly, hypopigmented, anaesthetic and hairless.
What is treatment of leprosy?
Treatment of tuberculoid leprosy should include daily dapsone and supervised monthly rifampicin for six months.
- Plasmodium falciparum
a. causes more severe disease in pregnancy
b. is associated with recurrent relapses after initial treatment because of liver hypnozoites
c. is the only malarial parasite causing greater than 20% parasitaemia
d. infection is typically associated with thrombocytopaenia
e. is the only cause of cerebral malaria
True a. causes more severe disease in pregnancy
False b. is associated with recurrent relapses after initial treatment because of liver hypnozoites
True c. is the only malarial parasite causing greater than 20% parasitaemia
True d. infection is typically associated with thrombocytopaenia
True e. is the only cause of cerebral malaria
- The following infectious diseases are correctly matched to their period of infectivity:
a. chicken pox: from appearance of rash until the last spot is crusted over
b. rubella: 7 days before onset of rash until 4 days after onset of rash
c. mumps: 7 days before salivary swelling until appearance of salivary swelling
d. scarlet fever: from appearance of rash until completion of 1 day’s penicillin
e. measles: from onset of prodrome until 4 days after onset of ras
False a. chicken pox: from appearance of rash until the last spot is crusted over
True b. rubella: 7 days before onset of rash until 4 days after onset of rash
False c. mumps: 7 days before salivary swelling until appearance of salivary swelling
True d. scarlet fever: from appearance of rash until completion of 1 day’s penicillin
True e. measles: from onset of prodrome until 4 days after onset of rash
Chicken pox: 5 days before rash to six days after last crop.
Mumps: 3 days before until 7 days after salivary swelling.
Whooping cough: 1 week after exposure to 3 weeks after onset of symptoms. The period of infectivity may be shortened by antibiotics.
- Amoebic liver abscess:
a. should be treated by diloxanide furoate alone
b. should be aspirated routinely
c. is associated with eosinophilia
d. usually affects the right lobe of the liver
e. occur most commonly in men aged 20-60 years
False a. should be treated by diloxanide furoate alone
False b. should be aspirated routinely
False c. is associated with eosinophilia
True d. usually affects the right lobe of the liver
True e. occur most commonly in men aged 20-60 years
In approximately 50% of cases there is no previous history of amoebic dysentery.
The patient typically presents with fever and right upper quadrant pain of fairly acute onset. Treatment of the fever with chloroquine may modify the clinical presentation.
Neutrophilia is usual, not eosinophilia.
Treatment is metronidazole and then diloxanide or paromomycin to kill GI parasites
- A woman who had not previously travelled abroad spent five days in Zambia. She went on safari on the fifth day and on the following day she became ill with fever and an erythematous rash. She is likely to be suffering from:
a. hepatitis A
b. loa loa
c. falciparum malaria
d. brucellosis
e. Hodgkin’s disease
All false
- In enteric fever
a. severe cases should receive high dose dexamethasone
b. ciprofloxacin is the treatment of choice in the UK. for adults
c. jaundice is a recognised complication
d. myocarditis is a recognised complication
e. if perforation of the bowel occurs it should be managed conservatively because surgery carries too high a mortality
True a. severe cases should receive high dose dexamethasone???
True b. ciprofloxacin is the treatment of choice in the UK. for adults??? Ceftriaxone
True c. jaundice is a recognised complication
True d. myocarditis is a recognised complication
False e. if perforation of the bowel occurs it should be managed conservatively because surgery carries too high a mortality.
- Hepatitis B.
a. Babies born to hepatitis B e antigen positive (HBeAg+ve) mothers should be given active and passive immunisation at birth.
b. According to current DHSS guidelines, children in the UK. should be vaccinated against hepatitis B by age 16.
c. Co-infection with delta virus may occur in intravenous drug abusers but occurs less commonly in homosexuals.
d. Super-infection with delta virus causes a clinical deterioration.
e. Is the major underlying cause of hepatocellular carcinoma.
a. Babies born to hepatitis B e antigen positive (HBeAg+ve) mothers should be given active and passive immunisation at birth.
b. According to current DHSS guidelines, children in the UK. should be vaccinated against hepatitis B by age 16.
c. Co-infection with delta virus may occur in intravenous drug abusers but occurs less commonly with homosexual transmission.
d. Super-infection with delta virus causes a clinical deterioration.
e. Is the major underlying cause of hepatocellular carcinoma.
- E.coli 0157 / H7:
a. is a bowel commensal
b. causes haemorrhagic colitis
c. is an important cause of cholera-like illness
d. is a recognised cause of the haemolytic uraemic syndrome
e. can be prevented from causing clinical illness by vaccination
False a. is a bowel commensal
True b. causes haemorrhagic colitis
False c. is an important cause of cholera-like illness
True d. is a recognised cause of the haemolytic uraemic syndrome
False e. can be prevented from causing clinical illness by vaccination
- Melioidosis:
a. is caused by Pseudomonas pseudotuberculosis
b. is more common in diabetics
c. should be treated with cefuroxime
d. is confined to equatorial Africa and South America
e. is commonly complicated by parotitis
False a. is caused by Pseudomonas pseudotuberculosis
True b. is more common in diabetics
False c. should be treated with cefuroxime
False d. is confined to equatorial Africa and South America
True e. is commonly complicated by parotitis
The causative organism is Pseudomonas pseudomallei.
The treatment of choice is ceftazidime. Cefuroxime does not cover Pseudomonas species.
- The following neoplasms have a known infective aetiology:
a. Burkitt’s lymphoma
b. squamous carcinoma of the penis
c. hepatocellular carcinoma
d. squamous carcinoma of the bronchus
e. nasopharyngeal carcinoma
True a. Burkitt's lymphoma True b. squamous carcinoma of the penis True c. hepatocellular carcinoma False d. squamous carcinoma of the bronchus True e. nasopharyngeal carcinoma
- Characteristic findings in visceral leishmaniasis (kala azar) include:
a. eosinophilia
b. pancytopaenia
c. polyclonal hypergammaglobulinaemia
d. positive leishmanin test
e. lymphadenopathy
False a. eosinophilia
True b. pancytopaenia - due to marrow suppression and hypersplenism
True c. polyclonal hypergammaglobulinaemia
False d. positive leishmanin test
True e. lymphadenopathy
- Parvovirus B19:
a. is the causative agent of fifth disease (erythema infectiosum)
b. was discovered after parvovirus B16
c. antibodies are present in 70% of the UK adult population
d. is a recognised cause of aplastic anaemia
e. is known to cause hydrops fetalis
True a. is the causative agent of fifth disease (erythema infectiosum)
False b. was discovered after parvovirus B16
True c. antibodies are present in 70% of the UK adult population
True d. is a recognised cause of aplastic anaemia
True e. is known to cause hydrops fetalis
Due to naming of Human Papilloma Virus HPV, it was named B19 after the well on a tray of early isolate. No parvo B16
- Subcutaneous nodules are a typical finding in:
a. neurofibromatosis
b. hydatid disease
c. cysticercosis
d. onchocerciasis
e. trichinosis
True a. neurofibromatosis False b. hydatid disease True c. cysticercosis True d. onchocerciasis False e. trichinosis
In hydatid disease the cysts are typically found in the liver and the lung.
- Characteristic features of kwashiorkor include:
a. patient aged less than 1 year
b. anorexia
c. flakey discoloured skin
d. hepatomegaly
e. splenomegaly
False a. patient aged less than 1 year True b. anorexia True c. flakey discoloured skin True d. hepatomegaly Fasle e. splenomegaly
The word kwashiorkor is from West Africa, originally meaning the child who has been displaced from the breast. It is most common in children aged 1-2 year
- Concerning meningococcal disease:
a. vaccine is available for meningococci groups A and C
b. sporadic outbreaks in the UK. are usually due to type B meningococcus
c. close contacts should be treated prophylactically with oral amoxycillin 3g as a single dose
d. outbreaks of disease occur seasonally in parts of sub-Saharan Africa.
e. is the most common cause of bacterial meningitis in the UK.
True a. vaccine is available for meningococci groups A and C
True b. sporadic outbreaks in the UK. are usually due to type B meningococcus
False c. close contacts should be treated prophylactically with oral amoxycillin 3g as a single dose
True d. outbreaks of disease occur seasonally in parts of sub-Saharan Africa.
True e. is the most common cause of bacterial meningitis in the UK.
N. meningitidis is the most common cause of bacterial meningitis in the UK and world wide. Asymptomatic nasal carriage occurs in 10-15% of normal people. Serious meningococcal disease is accompanied by the typical purpuric rash in two thirds of cases.
Contacts are usually given rifampicin 600mg b.d. for two days.
The part of Africa affected by epidemic meningitis is known as the meningitis belt. These outbreaks are caused by Group A organisms.
- Staphylococcus epidermidis:
a. is coagulase positive
b. on microscopy are Gram positive cocci in chains
c. are usually sensitive to penicillin
d. grown in blood cultures are due to contamination and should be ignored
e. are destroyed by povodine iodine
False a. is coagulase positive
False b. on microscopy are Gram positive cocci in chains
False c. are usually sensitive to penicillin
False d. grown in blood cultures are due to contamination and should be ignored
True e. are destroyed by povodine iodine
- Concerning tuberculin skin testing:
a. patients with tuberculous pericarditis are usually tuberculin positive
b. previous BCG vaccination usually results in a strongly positive reaction
c. pulmonary sarcoidosis gives a positive tuberculin test in about 30% of cases
d. if the sputum microscopy and culture are negative for mycobacteria, pulmonary tuberculosis can only be diagnosed if the tuberculin test is positive.
e. the test is usually negative in miliary tuberculosis
True a. patients with tuberculous pericarditis are usually tuberculin positive
False b. previous BCG vaccination usually results in a strongly positive reaction
True c. pulmonary sarcoidosis gives a positive tuberculin test in about 30% of cases
False d. if the sputum microscopy and culture are negative for mycobacteria, pulmonary tuberculosis can only be diagnosed if the tuberculin test is positive.
True e. the test is usually negative in miliary tuberculosis
- Hookworm
a. is usually spread by the faeco-oral route
b. is usually diagnosed by microscopy of adhesive tape prints taken from the perianal area
c. may block the pancreatic duct causing pancreatitis
d. eggs can be readily distinguished microscopically from those of Strongyloides sp.
e. commonly causes diarrhoea in non-immunes
all false
soil transmitted helminth
hookworm species include Necator americanus and Ancylostoma duodenale, which are indistinguishable on light microscopy
- The following are associated with an increased risk of vertical transmission of HIV
a. breast feeding
b. high titres of p24 antigen in maternal serum perinatally
c. low maternal CD4 counts during pregnancy
d. prolonged labour
e. HIV-1 compared to HIV-2
True a. breast feeding
True b. high titres of p24 antigen in maternal serum perinatally
True c. low maternal CD4 counts during pregnancy
False d. prolonged labour
True e. HIV-1 compared to HIV-2
breast feeding benefits usually outweigh risk of HIV transmission
- Concerning African trypanosomiasis
a. it has an incubation period of 4-6 months
b. it may cause erythema chronicum migrans in light skinned persons
c. the Gambian form progresses more rapidly
d. the Gambian form is associated with a more prominent chancre
e. the Gambian form can be treated with pentamidine
False a. it has an incubation period of 4-6 months
False b. it may cause erythema chronicum migrans in light skinned persons
False c. the Gambian form progresses more rapidly
False d. the Gambian form is associated with a more prominent chancre
True e. the Gambian form can be treated with pentamidine
circinate erythema may occur in light skinned people. Erythema chronicum migrans is characteristic of lyme disease
Rhodesian form more rapidly progressively
what is treatment of African trypanosomiasis?
Gambian
Rhodesian
eflornithine
melarsoprol
pentamidine
suramin
Gambian -
CNS not involved - pentamidine (1st choice) PLUS suramin or eflornithine
CNS involved - melarsaprol
Rhodesian -
CNS not involved - suramin
CNS involved - melarsaprol
Rhodesian tends to be more severe
Gambiense more likely present with Witnerbottom’s sign and chancre at inoculation site
- Vivax malaria
a. may be complicated by anaemia
b. may be complicated by jaundice
c. in a traveller may present more than six months after exposure
d. is sensitive to chloroquine
e. may co-exist with falciparum malaria in the same patient
all true
- The following infections are zoonoses
a. salmonellosis
b. leprosy
c. tularaemia
d. Weil’s disease (leptospirosis)
e. cholera
True a. salmonellosis Falseb. leprosy True c. tularaemia True d. Weil's disease (leptospirosis) False e. cholera
armadillo is only other vertebrate which develops leprosy
Salmonella Typhi only human-human transmission
- A fever of two weeks’ duration associated with neutropaenia is characteristically due to
a. disseminated tuberculosis
b. brucellosis
c. malaria
d. influenza B
e. amoebic liver abscess
True a. disseminated tuberculosis True b. brucellosis True c. malaria False d. influenza B False e. amoebic liver abscess
- Quinine
a. is gametocidal for mature gametocytes of Plasmodium falciparum.
b. is active against schizonts of Plasmodium malariae
c. resistance occurs in Plasmodium falciparum in South East Asia
d. cerebrospinal fluid levels are much lower than serum levels following oral or intravenous administration
e. causes hypoglycaemia
False a. is gametocidal for mature gametocytes of Plasmodium falciparum.
True b. is active against schizonts of Plasmodium malariae
True c. resistance occurs in Plasmodium falciparum in South East Asia
True d. cerebrospinal fluid levels are much lower than serum levels following oral or intravenous administration
True e. causes hypoglycaemia
Quinine is schizonticidal to all four types of malaria. The gametocytes of P.vivax, P.ovale and P.malariae are also susceptible. The mature gametocytes of P.falciparum and the hypnozoites of P.ovale and P.vivax are not susceptible.
Quinine-resistant P.falciparum has been reported in South East Asia.
Most anti-malarials are active against schizonts
- Rheumatic fever
a. is most common in the third decade
b. is more common in areas of social deprivation
c. causes erosive arthritis
d. relapse rate may be reduced by prophylactic antibiotics
e. is more common following streptococcal pharyngitis than streptococcal cellulitis
False a. is most common in the third decade
True b. is more common in areas of social deprivation
False c. causes erosive arthritis
True d. relapse rate may be reduced by prophylactic antibiotics
True e. is more common following streptococcal pharyngitis than streptococcal cellulitis
peak age onset 5-15 years
arthritis usually leaves the joints undamaged
streptococcal skin infections rarely cause rheumatic fever. Usually just streptococcal pharyngitis
- The following are correctly paired
a. erythema nodosum tuberculosis
b. erythema marginatum Lyme disease
c. erythema multiforme orf
d. erythema induratum syphilis
e. erythema infectiosum parvovirus B19
True a. erythema nodosum: tuberculosis
False b. erythema marginatum: Lyme disease
True c. erythema multiforme: orf
False d. erythema induratum: syphilis
True e. erythema infectiosum: parvovirus B19
- HIV-associated Kaposi’s sarcoma is
a. radiosensitive
b. chemosensitive
c. a cause of pleural effusion
d. more common in intravenous drug abusers than homosexuals
e. associated with infection by HHV-8 (Herpes hominis virus type 8)
True a. radiosensitive
True b. chemosensitive
True c. a cause of pleural effusion
False d. more common in intravenous drug abusers than homosexuals
True e. associated with infection by HHV-8 (Herpes hominis virus type 8)
The skin and palate are particularly common sites for KS. Cutaneous and lymph node KS responds to radiotherapy. Systemic KS (i.e. bowel, pulmonary) responds to chemotherapy: vincristine, bleomycin, etoposide.
- Cholera
a. Vibrio cholera of the 01 serotype is the only cause of clinical disease
b. low gastric pH protects against infection
c. cholera toxin produces its effect by reducing intracellular levels of cAMP
d. hypoglycaemia is a recognised complication in children
e. fever is usual in adults
False a. Vibrio cholera of the 01 serotype is the only cause of clinical disease
True b. low gastric pH protects against infection
False c. cholera toxin produces its effect by reducing intracellular levels of cAMP
True d. hypoglycaemia is a recognised complication in children
False e. fever is usual in adults
what is the structure of cholera toxin, and how does it work?
cholera toxin is an 84kDa protein consisting of one A (activating) and five B (binding) subunits. The A1 part of the A subunit enters the mucosal cell. Here it catalyses the transfer of ADP-ribose to GTP-binding regulatory protein. GTP regulatory protein is altered in conformation and this leads to reduced inhibition of adenyl cyclase. The intracellular concentration of cAMP rises and a net loss of isotonic fluid into the gut occurs.
- The following drugs are contraindicated or should be used with caution in epileptics:
a. doxycycline
b. chloroquine
c. ciprofloxacin
d. mefloquine
e. metronidazole
False a. doxycycline True b. chloroquine True c. ciprofloxacin True d. mefloquine False e. metronidazole
Mefloquine is contra-indicated in epileptics. In the normal population there is a 1 in 10,000 chance of serious neuropsychiatric complications. The risk is greater in epileptics.
Chloroquine should only be used with caution as it reduces seizure threshold. Doxycycline is an acceptable alternative for malaria prophylaxis. It is suitable for short term use and has the additional advantage of protecting against rickettsial infections, plague and leptospirosis.
Ciprofloxacin and other quinolones should be used with caution in epilepsy as they lower seizure threshold and may induce convulsions
- Hepatitis C
a. cirrhosis develops in most untreated cases
b. blood transfusion is the commonest mode of transmission in the UK.
c. most children born to hepatitis C infected mothers will have the infection
d. a normal serum alanine transaminase level excludes active liver disease
e. genotype 1 has the most favourable response to treatment
All false
The ALT level is not closely associated with the severity of liver disease so most HCV-RNA positive patients are offered liver USS/ biopsy
10-20% of cases develop chronic active hepatitis or cirrhosis. 3% develop hepatocellular carcinoma.
HCV transmission: most cases are due to intravenous drug abuse / needle-sharing. Sexual transmission accounts for about 5% of cases as does vertical transmission. In the U.K. all donated blood has been screened since 1991.
- Coagulopathy is a recognised complication of
a. epidemic typhus
b. relapsing fever
c. pneumococcal septicaemia
d. envenomation by Latrodectus spiders (black widow spiders)
e. envenomation by Physalia physalis (Portuguese-man-of-war)
True a. epidemic typhus
True b. relapsing fever
True c. pneumococcal septicaemia
False d. envenomation by Latrodectus spiders (black widow spiders)
False e. envenomation by Physalia physalis (Portuguese-man-of-war)
Haemorrhagic rash is a characteristic feature of both epidemic typhus and relapsing fever. DIC is a potential complication of septicaemia.
Envenomation by the black widow spider causes local reactions, neurotoxicity, sweating and muscle spasm. Coagulation defects are not well described.
Likewise with stings from a Portuguese-man-of-war, local reactions, cardiovascular toxicity and muscle spasms may occur but coagulopathy is not well described.
Coagulopathy may follow envenomation by African pit vipers.
- Cryptococcal meningitis
a. is caused only by Cryptococcus neoformans neoformans
b. is more common than cryptococcal pneumonia
c. characteristically causes leucopaenia
d. only occurs in the immunosuppressed
e. should be treated with ketoconazole
False a. is caused only by Cryptococcus neoformans neoformans
True b. is more common than cryptococcal pneumonia
False c. characteristically causes leucopaenia
False d. only occurs in the immunosuppressed
False e. should be treated with ketoconazole
Ketoconazole does not cross the blood brain barrier. Usually treatment is with intravenous amphoteracin B with or without flucytosine. In AIDS patients relapse is inevitable and lifelong prophylaxis with fluconazole or itraconazole is recommended. High dose fluconazole has been used successfully for treatment as an alternative to amphoteracin B.
