Tropical Medicine 3 Flashcards
- Thalidomide is used in the treatment of
a. HIV-associated peripheral neuropathy
b. hyperemesis gravidarum
c. erythema nodosum leprosum
d. Behcet’s disease
e. HIV-associated mouth ulcers
False a. HIV-associated peripheral neuropathy False b. hyperemesis gravidarum True c. erythema nodosum leprosum True d. Behcet's disease True e. HIV-associated mouth ulcers
- Hepatitis A vaccination (Havrix):
a. is a live vaccine
b. is teratogenic
c. has >75% protective efficacy
d. causes mild hepatitis in some patients
e. should be offered to haemophiliacs who are hepatitis A antibody negative
False a. is a live vaccine
False b. is teratogenic
True c. has >75% protective efficacy
False d. causes mild hepatitis in some patients
True e. should be offered to haemophiliacs who are hepatitis A antibody negative
Two doses four weeks apart result in seroconversion in nearly all cases and protection lasts about five years. It may be given with human normal immunoglobulin or other live or inactivated vaccines.
Vaccination is aimed primarily at frequent travellers, military personnel and aid workers. It should also be considered for sewage workers, staff in mental handicap institutions, haemaphiliacs and for those with chronic liver disease.
Use in post-exposure prophylaxis is not yet established nor is it of proven efficacy.
- Yellow fever
a. has an incubation period of 3-6 days
b. has a case fatality rate of about 50%
c. is caused by a flavivirus
d. is spread by anopheline mosquitoes
e. epidemics should be controlled by strict isolation of cases
True a. has an incubation period of 3-6 days
False b. has a case fatality rate of about 50%
True c. is caused by a flavivirus
False d. is spread by anopheline mosquitoes
False e. epidemics should be controlled by strict isolation of cases
Yellow fever is spread by culicine mosquitoes: Aedes aegypti (peri-domestic) and Aedes haemogogus (sylvatic)
- Tuberculosis control:
a. Sputum negative cases of pulmonary tuberculosis are of more public health importance than sputum positive cases because they are more likely to remain undiagnosed.
b. Children with tuberculosis have usually acquired their disease from a child contact.
c. Close contacts of a sputum positive case should be offered immediate BCG.
d. BCG is at least 50% effective in preventing pulmonary tuberculosis.
e. Twice weekly supervised treatment regimens have comparable efficacy to standard daily regimens.
Tuberculosis control:
False a. Sputum negative cases of pulmonary tuberculosis are of more public health importance than sputum positive cases because they are more likely to remain undiagnosed.
False b. Children with tuberculosis have usually acquired their disease from a child contact.
False c. Close contacts of a sputum positive case should be offered immediate BCG.
False d. BCG is at least 50% effective in preventing pulmonary tuberculosis.
True e. Twice weekly supervised treatment regimens have comparable efficacy to standard daily regimens.
The main thrust of public health policy in the control of tuberculosis is the identification and treatment of sputum positive cases. These are the most infectious patients
- Strep. pyogenes
a. is the most common bacterial cause of tonsillitis
b. asymptomatic pharyngeal carriage occurs in about 10% of children
c. septicaemia carries a mortality similar to meningococcal septicaemia
d. pharyngitis may be complicated by suppurative cervical adenitis
e. causes scarlet fever
All true
- Amphotericin B is used in the treatment of:
a. visceral leishmaniasis
b. dermatophyte infections of the nails
c. azole resistant oral candida
d. primary amoebic meningoencephalitis caused by Naegleria species
e. cryptococcal meningitis
True a. visceral leishmaniasis
False b. dermatophyte infections of the nails
True c. azole resistant oral candida
True d. primary amoebic meningoencephalitis caused by Naegleria species
True e. cryptococcal meningitis
Amphotericin B is a polyene antifungal which is not absorbed orally but which can be given parenterally for the treatment of severe systemic fungal infections.
Amphotericin B also has activity against Trichomonas, Entamoeba, Naegleria, Leishmania and trypanosomes.
Griseofulvin or terbinafine can be used in the treatment of dermatophyte nail infections.
- Typical features of tropical pulmonary eosinophilia include:
a. lymphadenopathy
b. absolute eosinophilia
c. microfilaraemia
d. raised serum Ig E
e. rapid response to mebendazole
True a. lymphadenopathy True b. absolute eosinophilia False c. microfilaraemia True d. raised serum Ig E False e. rapid response to mebendazole
- The following drugs are used in the treatment of Legionnaires’ disease:]
a. rifampicin
b. gentamicin
c. erythromycin
d. ciprofloxacin
e. azithromycin
True a. rifampicin False b. gentamicin True c. erythromycin True d. ciprofloxacin True e. azithromycin
- Acute post-streptococcal glomerulonephritis of childhood:
a. occurs after cellulitis but not pharyngitis
b. should be treated with steroids
c. is fatal in about half of all cases
d. is usually crescentic on microscopy
e. usually presents with acute renal failure
True a. occurs after cellulitis but not pharyngitis
False b. should be treated with steroids
False c. is fatal in about half of all cases
False d. is usually crescentic on microscopy
False e. usually presents with acute renal failure
- Suppurative lymphadenopathy may be caused by:
a. cat scratch fever
b. lymphogranuloma venereum
c. tuberculosis
d. sarcoidosis
e. plague
True a. cat scratch fever True b. lymphogranuloma venereum True c. tuberculosis False d. sarcoidosis True e. plague
What are causes of suppurative lymphadenopathy?
Strep. pyogenes tuberculosis plague chancroid cat scratch fever tularaemia lymphogranuloma venereum
- Legionnaires’ disease:
a. can be acquired by drinking infected water
b. smokers are more susceptible
c. most cases are sporadic
d. hyponatraemia is typical
e. may cause rigors
False a. can be acquired by drinking infected water True b. smokers are more susceptible True c. most cases are sporadic True d. hyponatraemia is typical True e. may cause rigors
Laboratory features include leucocytosis, hyponatraemia and raised liver transaminases.
- Typical features of botulism include:
a. circumoral parasthaesia
b. extensor plantars
c. diarrhoea
d. fever
e. post-tetanic potentiation on EMG (electromyography)
False a. circumoral parasthaesia False b. extensor plantars False c. diarrhoea False d. fever True e. post-tetanic potentiation on EMG (electromyography)
Botulism usually results from ingestion of pre-formed botulinum toxin in canned or smoked food. The toxin is produced by Clostridium botulinum. It is heat labile. It acts pre-synaptically at neuromuscular junctions preventing the release of acetylcholine.
Features include ptosis, dry mouth, diplopia, blurred vision, bulbar palsy and muscular weakness. Sensory signs are not a feature. (Circumoral parasthesia is typical of hyperventilation.) Nausea and vomiting may occur but not usually diarrhoea. Symptoms occur 12-72 hours after ingestion of the toxin.
Diagnosis is by animal tests: mice are injected with small samples of serum, urine or gastric contents from the patient and watched for signs of botulism. EMG shows post tetanic potentiation.
Treatment. Respiratory support and polyvalent horse antiserum.
- Concerning anti-tuberculous chemotherapy:
a. pyrazinamide causes hyperuricaemia
b. isoniazid causes a lupus-like syndrome
c. twice weekly regimens should be continued for at least 12 months
d. pyridoxine is only needed by slow acetylators
e. rifampicin can only be given orally
True a. pyrazinamide causes hyperuricaemia
True b. isoniazid causes a lupus-like syndrome
False c. twice weekly regimens should be continued for at least 12 months
False d. pyridoxine is only needed by slow acetylators
False e. rifampicin can only be given orally
What are common side effects of:
Rifampicin
isoniazid
pyrazinamide
Rifampicin can be given orally or intravenously. Transient elevation of transaminases is common. Six toxicity syndromes have been described: influenzal, abdominal, respiratory, shock, renal and thrombocytopaenic.
Compliance is a major problem in the developing world. Expense, cultural beliefs, the need to travel to get the drugs, drug side effects and variable drug supply all contribute towards poor compliance
Isoniazid is generally safe. The most common side effect is peripheral neuropathy. This is more common in diabetes and alcoholics. Pyridoxine should always be given to such patients. Slow acetylator status increases risk of neuropathy and of lupus-like syndrome. Other side effects include psychosis, fever and hepatitis.
Pyrazinamide is bactericidal and penetrates the meninges well. Its side effects include fever, liver failure and hyperuricaemia.
