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Questions and Answers

Which risk factor is NOT associated with Kaposi Sarcoma?

  • AIDS patient
  • Homosexual
  • Female gender (correct)
  • Mediterranean ancestry

    • How is Chicken Pox primarily transmitted?

  • Contaminated surfaces
  • Mother to child during pregnancy
  • Inhalation of respiratory droplets (correct)
  • Blood transfusion

    • What is the minimum duration of the infectious period for Chicken Pox?

  • 3 days after rash
  • 6 days after rash
  • 4 days before rash
  • 2 days before rash (correct)

    • Which of the following symptoms is NOT typical of Chicken Pox?

    <p>Dry cough</p> Signup and view all the answers

    When can children return to school after having Chicken Pox?

    <p>After vesicles have dried out and crusted</p> Signup and view all the answers

    Under which circumstance should a mother with HIV breastfeed her baby?

    <p>Never</p> Signup and view all the answers

    What should a mother do if she has candidiasis of the nipple?

    <p>Continue breastfeeding, as it is safe</p> Signup and view all the answers

    Which condition requires immediate attention and vaccination for a newborn if the mother has tuberculosis?

    <p>BCG vaccination</p> Signup and view all the answers

    Which statement is true regarding psychological conditions and breastfeeding?

    <p>Only Sertraline is classified as safe during breastfeeding</p> Signup and view all the answers

    In which situation should a nursing mother avoid breastfeeding while having Hepatitis C?

    <p>If she is experiencing cracked or bleeding nipples</p> Signup and view all the answers

    Which symptom is NOT typically associated with meningitis in babies and toddlers?

    <p>High pitched cry</p> Signup and view all the answers

    What is a critical first step in the treatment of suspected meningitis?

    <p>Notify the health protection team</p> Signup and view all the answers

    Which finding may indicate the presence of increased intracranial pressure?

    <p>Tense bulging fontanelle</p> Signup and view all the answers

    What clinical sign suggests meningococcal infection in a patient with meningitis?

    <p>Rash</p> Signup and view all the answers

    What should be performed to assess the condition of a patient suspected of meningitis without a rash?

    <p>Lumbar puncture</p> Signup and view all the answers

    Which of the following is NOT an associated finding in meningitis?

    <p>Severe back pain</p> Signup and view all the answers

    What does the presence of photophobia in a patient indicate in the context of meningitis?

    <p>Neurological involvement</p> Signup and view all the answers

    Which of the following complicates the diagnosis and treatment of meningitis?

    <p>Intracranial pressure elevation</p> Signup and view all the answers

    Which drug is specifically indicated for the treatment of non-falciparum malaria?

    <p>Chloroquine</p> Signup and view all the answers

    What is the primary use of Primaquine in malaria treatment?

    <p>To destroy liver stage parasites and prevent relapse</p> Signup and view all the answers

    Why must patients be screened for G6PD deficiency before starting Primaquine?

    <p>It can cause severe haemolysis in deficient patients</p> Signup and view all the answers

    What is the main reason Chloroquine may not be effective in some regions?

    <p>Chloroquine resistance in local malaria strains</p> Signup and view all the answers

    Which of the following is a contraindication for Primaquine use?

    <p>Lactating women</p> Signup and view all the answers

    What is the gold standard for the diagnosis of Brucellosis?

    <p>Direct isolation of Brucella spp</p> Signup and view all the answers

    In what situation is Quinine recommended for malaria treatment?

    <p>When chloroquine fails to resolve the infection</p> Signup and view all the answers

    Which of the following is NOT a common feature of Brucellosis?

    <p>Severe pain over the affected area</p> Signup and view all the answers

    Which malarial stage does Chloroquine primarily target?

    <p>Red blood cells infected by the parasite</p> Signup and view all the answers

    In the treatment of cerebral toxoplasmosis, what is the first course of action?

    <p>Start empirical antibiotics immediately</p> Signup and view all the answers

    Which of the following patient conditions is a significant risk factor for necrotising fasciitis?

    <p>Recent chemotherapy</p> Signup and view all the answers

    What is the appropriate action when traveling to an area where chloroquine resistance is known?

    <p>Use mefloquine as prophylaxis</p> Signup and view all the answers

    Which antibiotic is NOT effective for treating necrotising fasciitis?

    <p>Flucloxacillin</p> Signup and view all the answers

    What is a characteristic feature that differentiates necrotising fasciitis from erysipelas?

    <p>All of the above</p> Signup and view all the answers

    What is the primary pathogen responsible for necrotising fasciitis?

    <p>Group A beta-hemolytic streptococci</p> Signup and view all the answers

    In the context of cerebral toxoplasmosis, which temperature criterion indicates that reactivation may occur in HIV patients?

    <p>Both A and C are correct</p> Signup and view all the answers

    What should be administered if a person is unsure of their vaccination status and has a tetanus-prone wound?

    <p>Tetanus vaccine and tetanus immunoglobulin</p> Signup and view all the answers

    For an adult who has not been immunized, how long should the first three doses of the tetanus vaccine be given apart?

    <p>1 month apart</p> Signup and view all the answers

    What indicates that a child is overdue for their next routine tetanus immunization?

    <p>Completed priming course but no booster recently</p> Signup and view all the answers

    What immunization status is required for a clean wound in an adult?

    <p>Completed priming course and booster in the past 10 years</p> Signup and view all the answers

    What is the typical time between the first booster and the second booster for adults?

    <p>5 years</p> Signup and view all the answers

    Which of the following examples represents a high-risk tetanus-prone wound?

    <p>Wounds displaying extensive devitalized tissue</p> Signup and view all the answers

    What vaccine is recommended for children who have not been immunized?

    <p>Diphtheria, tetanus, and pertussis combined vaccine</p> Signup and view all the answers

    When administering the first three doses of the tetanus vaccine to children, how should they be spaced?

    <p>1 month apart</p> Signup and view all the answers

    Which of the following is NOT a characteristic of a high-risk tetanus-prone wound?

    <p>Burns with no devitalized tissue</p> Signup and view all the answers

    What is recommended if a person has completed their priming course and received the last tetanus vaccine over 10 years ago?

    <p>Administer booster and tetanus immunoglobulin</p> Signup and view all the answers

    Study Notes

    Infectious Diseases Summary

    • Respiratory Infections:

      • Community-acquired pneumonia (mild): Amoxicillin
      • Community-acquired pneumonia (moderate): Amoxicillin + Clarithromycin
      • Community-acquired pneumonia (severe): Co-amoxiclav + Clarithromycin
      • Pneumocystis Jirovecii pneumonia (prev as "P. Carinii"): Co-trimoxazole (trimethoprim + sulfamethoxazole)
      • Tuberculosis (TB): First 2 months (RIPE): Rifampicin, Isoniazid, Pyrazinamide, Ethambutol. Next 4 months (RI): Rifampicin and Isoniazid.
      • Aspiration pneumonia (community acquired): Amoxicillin + Metronidazole

    • Pneumonia:

      • Treatment for penicillin allergy: Clarithromycin or Doxycycline.
      • Caution with statins: Avoid clarithromycin if patient is taking a statin due to increased risk of rhabdomyolysis

    • Central Nervous System Infections:

      • Out-of-hospital meningitis: Benzylpenicillin
      • In-hospital meningitis: Cefotaxime IV or Ceftriaxone IV
      • Listeria meningitis: Amoxicillin + Gentamicin
      • Cryptococcal meningitis: Amphotericin B
      • Meningitis prophylaxis (for contacts): 1st line: Ciprofloxacin. 2nd line: Rifampicin
      • Empirical treatment for meningitis (patient >60): IV ceftriaxone and IV amoxicillin

    • Gastrointestinal Infections:

      • Salmonella: Ciprofloxacin OR Cefotaxime
      • Shigella/Campylobacter: Erythromycin OR Azithromycin OR Clarithromycin OR Ciprofloxacin
      • Clostridium difficile (Pseudomembranous colitis):
        • Mild: Oral Metronidazole
        • Severe: Vancomycin
      • Helicobacter pylori: OAC or OAM (Omeprazole, Amoxicillin, Clarithromycin or Metronidazole)

    • Clostridium difficile vs Norovirus:

      • Clostridium Difficile: Severe diarrhoea + recent use of broad spectrum antibiotics + spreads easily in wards
      • Norovirus: Severe diarrhoea + spreads easily in wards

    • Ear, Nose & Throat Infections:

      • Acute bacterial otitis media: Amoxicillin
      • Upper respiratory tract infection (Pharyngitis, Tonsillitis, Laryngitis): Phenoxymethylpenicillin

    • Laryngitis:

      • Investigation: None required.

    • Skin, Joint, and Other Infections:

      • Cellulitis: Flucloxacillin
      • Mastitis: Flucloxacillin
      • Diabetic Foot Infection: Specific treatment varies
      • Scabies: Permethrin 5% topical
      • Septic Arthritis: Flucloxacillin, Vancomycin (MRSA)
      • Osteomyelitis: Specific treatment varies
      • Toxoplasmosis: Pyrimethamine + Sulfadiazine

    • Oral Thrush (Oral candidiasis):

      • Features: Thick white marks, inflamed mouth/tongue, can be rubbed out, red inflamed sore mouth angles.
      • Contributing factors: Immunosuppression (diabetes, recent antibiotic use, regular steroids), smoking, elderly, pregnancy.
      • Treatment: Stop smoking, good inhaler technique and hygiene (e.g., use a spacer and rinse mouth after use), 1st line: oral miconazole gel, oral fluconazole 50mg OD 7 days in severe cases.

    • Leukoplakia:

      • Features: Raised edges, bright white patches, sharply defined, cannot be rubbed out.
      • Contributing factors: Smoking history.
      • Investigation: Biopsy (premalignant for SCC).
      • Treatment: Smoking cessation, observe or surgical excision depending on biopsy result

    • Streptococcus Pneumoniae:

      • Facts: Most common cause of pneumonia, gram +ve diplococci.
      • Features: Productive cough, fever, chest tightness, unilateral basal crackles on auscultation, unilateral lobar consolidation on X-ray.
      • Association: Herpes Labialis.

    • Different Types of Pneumonia:

      • Pneumococcal streptococcal: Herpes Labialis, typical features of community-acquired pneumonia, productive cough, fever, unilateral basal crackles, unilateral basal consolidation.
      • Mycoplasma: Erythema multiforme, atypical features (young adult, dry cough), bilateral consolidation, patchy consolidation of 1 lower lobe.
      • Pneumocystis jirovecii: HIV with CD4 < 200, + desaturation on exercise, dry cough, bilateral consolidation, exertional dyspnea.
      • Staph. aureus: Pneumonia after influenza (flu), common in IV drug abusers and elderly, bilateral cavitation.
      • Legionella: Pneumonia after exposure to water (e.g., hotel), low sodium, low lymphocytes, bibasal consolidation, macrolides/tetracyclines are usual treatment of choice.
      • Klebsiella: Cavitating pneumonia, particularly upper lobe, bacterial pneumonia.

    • Type of Pneumoniae:

      • HIV patient with lobar consolidation (CD4 count 350): Streptococcus pneumoniae
        • Child with purulent CSF: Streptococcus pneumoniae (if neisseria is not an option)
        • IV drug user with bilateral cavitation and recent flu-like symptoms: Staphylococcus aureus

    • Tuberculosis:

      • Facts: Caused by Mycobacterium Tuberculosis (acid-fast bacilli), travelling history, high-risk groups (homeless, drug abusers, smokers, low socioeconomic class).
      • Diagnosis: Sputum staining for acid-fast bacilli, Bronchoalveolar lavage, Gastric lavage (if sputum not obtained).
      • High risk factors: Homeless, drug abuser, smoker, low socioeconomic class.
      • Features: Chronic productive cough, hemoptysis (coughing up blood), weight loss (cachexia), fatigue, night sweats, small area of caseating granulomas, upper lobe consolidation, infiltration, cavitation on chest X-ray, cervical/supraclavicular lymph nodes may be initially tender, firm and discrete on palpation but later become suppurative.
      • Main symptoms of Pulmonary tuberculosis: Central (appetite loss, fatigue); Lungs (chest pain, coughing up blood, prolonged cough), Skin (night sweats, pallor).
      • Screening for contacts of tuberculosis patient: Mantoux test for contacts who have not been vaccinated with BCG, Interferon gamma test for contacts who have been vaccinated with BCG.
      • Treatment: First 2 months (RIPE): Rifampicin, Isoniazid, Pyrazinamide, Ethambutol. Next 4 months (RI): Rifampicin, Isoniazid.
      • Directly Observed Therapy (DOT): For patients who need support to manage TB (homeless, imprisoned, drug/alcohol misuse, patients not adherent to therapy, those too ill to adhere to therapy). Toxoplasmosis can present with splenomegaly and cervical lymphadenopathy but weight loss isn't seen.
      • Tuberculous Lymphadenitis: Contributing factors (traveling history, especially to/from India), features (fever, cough, cervical lymphadenopathy, caseating granuloma in lymph nodes). Difference from sarcoidosis and Crohn's (non-caseating granuloma).
      • Laryngeal TB: Contributing factors (IV drug abuse, low socioeconomic status), features (fever, cough, cervical lymphadenopathy, hoarseness, dysphagia, weight loss), 35 year old homeless man with these symptoms.
      • Side effects of Anti-TB drugs: Rifampicin (uric acid increase, gout risk, peripheral neuritis, hepatitis), Streptomycin (visual problems e.g., red-green discrimination, ↓visual activity, optic neuritis), Isoniazid (visual problems, ototoxic, potential deafness, contraindicated in pregnancy), Ethambutol (uric acid increase, gout risk, visual problems, ototoxic, potential deafness). Streptomycin is contraindicated during pregnancy.

    • Scabies:

      • Facts: Organism: Sarcoptes scabiei (parasite), transmitted by skin-to-skin contact, causes allergic reaction, pruritus (itching) is NOT the infection.
      • Features: Linear tracks (burrows), severe pruritus (particularly at night), typically found in skin folds (e.g., wrists, finger webs, elbow, axilla, areola, genitalia).
      • Treatment: Permethrin 5% cream, treat all close contacts simultaneously.
      • Keywords: Sarcoptes, very itchy, linear tracks on skin, allergic reaction, permethrin.

    • Gastroenteritis:

      • Features: Nausea, vomiting, diarrhea (with or without blood), abdominal pain.
      • Investigations: Stool microscopy, culture and sensitivity, FBC, renal function, electrolytes.
      • Treatment: Usually conservative (hydration). Severe bloody diarrhea: Campylobacter jejuni (Clarithromycin), Salmonella (Ciprofloxacin).
      • UK patient return to work: 48 hours after last symptom (diarrhea or vomiting).

    • Meningitis (general):

      • Delayed complication: Hearing loss
      • MUST arrange hearing test: No later than 4 weeks after treatment.

    • Meningitis (in babies and toddlers):

      • Features/Symptoms: Fever, cold hands and feet, refusing food and vomiting; Fretful, dislike being handled; Unusual crying, moaning; Pale, blotchy skin; Tense, bulging fontanell (soft spot); Drowsy, floppy, unresponsive, Rapid breathing and grunting; Stiff neck; dislike bright lights; Rash; seizures.

    • Kaposi Sarcoma:

      • Facts: Cancer of connective tissue, most commonly caused by HIV/AIDS
      • Features: Red, purple, brown, or black nodules or papules; usually non-painful; common sites – mouth, nose, throat; can grow internally (e.g., lungs, GI tract).
      • Risk Factors: Homosexual, Mediterranean, Jewish, Bisexual, AIDS patient.

    • Chicken Pox:

      • Cause: Varicella zoster virus (VZV).
      • Infectious Route: Very contagious, mainly via respiratory route (airborne), transmitted by direct contact with vesicles. Dried out/crusted vesicles do not transmit.
      • Infectious Period: 2 days before rash; 5 days after rash first appears; stop when vesicles dry out and crust.
      • Features: Fever (38-39°C), pruritic (itchy) rash, rash stages (macules, papules, vesicles, dry crusts); usually starts on face or trunk, then spreads over entire body.
      • Management (adults): Reassurance + supportive measures (paracetamol for fever, antihistamines and calamine lotion for itching) + Oral antibiotic if superimposed infection is suspected.
      • Management (children < 12): Reassurance + supportive measures (paracetamol for fever, antihistamines and calamine lotion for itching) + Oral antibiotic if superimposed infection is suspected.
      • Management (exposure): Oral aciclovir.
      • Management (immunocompromised): VZIG, acyclovir, assess risk, serology for varicella immunity, immunocompromised- HIV positive, diabetic, on long-term steroids.

    • Shingles:

      • Facts: Reactivation of VZV. Immunocompromised old patients. Chickenpox at initial infection
      • Features: Painful skin rash with blisters in localized area.
      • Management: Obtain serology for varicella immunity in immunocompromised patients. Immunocompromised- HIV positive, diabetic, on long-term steroids.
      • Treatment: Aciclovir, pain management

    • Ramsay Hunt Syndrome:

      • Facts: Reactivation of VZV, localized in geniculate ganglion of the facial nerve (7th CN).
      • Features: Facial palsy (ipsilateral facial palsy, loss of taste), otalgia (ear pain), tinnitus, vertigo, unilateral hearing loss, painful rash or vesicles around ears or on auditory canal.
      • Treatment: Oral aciclovir, oral corticosteroid, amitriptyline for pain.

    • Herpes Zoster Ophthalmicus:

      • Facts: Reactivation of VZV, localized in ophthalmic branch of trigeminal nerve (5th CN).
        • Features: Conjunctivitis. Keratitis, painful rash or vesicles around eyes, Hutchinson's Sign (vesicles on the tip of the nose).
      • Treatment: Oral aciclovir, oral corticosteroids, same day ophthalmology review, possible IV aciclovir for severely immunocompromised or systemic issues.

    • Lyme Disease (Lyme borreliosis):

      • Beginning Stage: Erythema migrans (erythematous, painless, non-itchy rash), fever, headache, myalgia, general aches.
        • Later Stage: Facial paralysis, encephalitis, meningitis, AV heart block, myocarditis, arthritis.
      • Diagnosis: Check for antibodies to Borrelia burgdorferi.
      • Treatment: Doxycycline or Amoxicillin (if contraindicated, e.g., pregnancy), Ceftriaxone (in disseminated disease).

    • Meningitis Treatment:

      • General: Health protection team must be notified immediately. Look out for: Arthralgia, muscle aches, cold periphery, pale or mottled skin, SOB, rash, photophobia, severe headache, neck stiffness, septicemia.
      • GP setting: IM or IV Benzylpenicillin.
      • Hospital setting: IV Ceftriaxone or Cefotaxime.
        • Allergy to Penicillin: Chloramphenicol.

    • Meningitis (Listeria): Amoxicillin or Ampicillin + Gentamicin

    • Meningitis (Cryptococcal): Amphotericin B

    • Meningitis prophylaxis: Ciprofloxacin, Rifampicin

    • Schistosomiasis:

      • Features: Hx of travel to Africa, (mostly), Haematuria, urinary bladder calcification, ulceration and obstructive uropathy, increased bladder cancer risk, hepatomegaly. Caused by 2 species (S. mansoni, S. haematobium).
      • Investigations: X-ray (urinary bladder calcification), ultrasounds (hydronephrosis), thickened bladder wall), CT scan (urinary bladder calcification, obstructive uropathy).
      • Similar organisms: Schistosoma mansoni.

    • Malaria:

      • Features: Hx of travel to Africa, intermittent fevers, rigors, headache, malaise, cough, myalgia, gastrointestinal upset, hepatosplenomegaly, jaundice.
      • Investigations: Microscopy of thick and thin blood film (most accurate), full blood count, rapid diagnostic test (adjunct to blood films, not a replacement).
      • Important note: Prophylaxis does not prevent all types of malaria.
      • Cerebral Malaria: Hx of travel to malaria-affected areas, meningitis-like symptoms (fever, chills, neck stiffness, vomiting, impaired consciousness), anaemia. Different from meningitis.
      • Treatment: Prophylaxis for Malaria (Chloroquine for non-falciparum malaria, Primaquine).

    • Needle Stick Injuries:

      • Protocol: Wash with soap and water, encourage bleeding, investigate for blood-borne infections.
      • Low risk: Safe sexual practices, does not use IV drugs.
      • High risk: IV drug abusers, drug addicts. PEP, healthcare pro for HBV surface antibody, offer HBV booster if needed.
      • Follow-up: Check for HIV and HCV in 6 weeks. Always test for HIV, HCV, and HBV.

    • Vaccine (HIV positive patients): Avoid BCG, MMR, and Yellow fever vaccines.

    • Tetanus Prophylaxis:

      • Wound risk: High risk (dirty, contaminated, compound fracture), low risk (clean).
      • Immunization status: Fully immunised and up-to-date, unknown or incomplete, need to be completed.

    • Abscess:

      • Features: High fever, erythematous skin swelling, neck abscess if large enough can cause dysphagia.
      • Treatment: IV antibiotics, incision, drainage. If patient is unwell, sepsis must be considered.

    • Whipple's Disease:

      • Facts: Rare multisystem disorder, caused by Tropheryma whipplei infection.
      • Features: Malabsorption (weight loss and diarrhea), large joint arthralgia, lymphadenopathy, skin hyperpigmentation and photosensitivity, pleurisy, pericarditis, neurological symptoms (rare: ophthalmoplegia, dementia, seizure, ataxia, myoclonus).
      • Investigations: Jejunal biopsy shows stunted villi, macrophages containing periodic acid-Schiff (PAS) granules.
      • Treatment: Co-trimoxazole for a year, preceded by a course of IV penicillin.

    • Other Information:

      • Important Investigation Results: Jejunal biopsy for Whipple's, celiac disease (villous atrophy, crypt hyperplasia, lymphocytosis), lymphoma in celiac patients (lymphomatous infiltrates).
      • Mastitis/Breast Abscess: Common cause Staph. Aureus, use notes on breastfeeding (Avoid/Continue).
      • Rabies: Vaccination indicated only for bat bites.
      • Cellulitis Treatment: First line – Flucloxacillin, Doxycycline, Erythromycin, Clarithromycin. Other options – Clindamycin.

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