ID: General

Question 1

Rx osteomyelitis

Answer 1

Vanc + Ceftriaxone

Question 2

Rx Legionnaire’s

Answer 2

Azithromycin

Question 3

RX crabs

Answer 3

Malathion

Question 4

Gram + Rods (bacilli)

Answer 4

Actinomyces
Bacillus antracis
Clostridium
Corynebacterium diphtheriae
Listeria monocytogenes

Question 5

Gram +ve Cocci

Answer 5

makes catalase: Staphylococci

does not make catalase: Streptococci

Question 6

what can be rx with bendazoles

Answer 6

Cestodes (tapeworms): Echinococcus granulosus, Taenia solium

Nematodes (roundworms):
Strongyloides stercoralis,
Enterobius vermicularis (pinworm),
Ancylostoma duodenale, Necator americanus (hookworms),
Trichinella spiralis
Ascaris lumbricoides (giant roundworm)

Question 7

What can be rx with Praziquantel

Answer 7

Trematodes (flukes)
Schistosoma haematobium
Paragonimus westermani
Clonorchis sinensis

Question 8

prophylaxis for contacts of patients with meningococcal meningitis

Answer 8

Oral ciprofloxacin
2nd ln rifampicin

Question 9

Meningitis Initial empirical 3 mo.- 50 years and most common bugs

Answer 9

Intravenous cefotaxime (or ceftriaxone)
Neisseria meningitidis, Haemophilus influenzae up to 6 y/o,
Streptococcus pneumoniae

Question 10

Meningitis: empirical > 50 years

Answer 10

IV cefotaxime (or ceftriaxone)
+ amoxicillin (or ampicillin)

• Streptococcus pneumoniae
• Neisseria meningitidis
• Listeria monocytogenes (>60 y/o)

Question 11

Meningitis: rx Meningococcal meningitis & Prophylaxis

Answer 11

IV benzylpenicillin/cefotaxime (or ceftriaxone)

prophylaxis : oral ciprofloxacin or rifampicin - needs to be offered to household and close contacts of patients affected with meningococcal meningitis

Question 12

Meningitis: empirical < 3 months

Answer 12

Intravenous cefotaxime + amoxicillin (or ampicillin)

• Group B Streptococcus (most common cause in neonates)
• E. coli
• Listeria monocytogenes

Question 13

rx Meningitis caused by Listeria

Answer 13

Intravenous amoxicillin (or ampicillin) + gentamicin

Question 14

Bacterial meningitis CSF

Answer 14

Bacterial meningitis

Appearance: Clear, cloudy, or purulent

Opening pressure: Usually elevated (>25 cmCSF)

WBC count: >100 cells/µL; >90% PMN

Glucose level: Low (< 40% of serum glucose)

Protein level: Elevated (>50 mg/dL)
Additional tests: CSF Gram stain and cultures, blood cultures, CSF bacterial antigens, CSF polymerase chain reaction (PCR) for common viruses

Question 15

csf Viral meningitis

Answer 15

Viral meningitis

Appearance: Clear

Opening pressure: Normal or elevated

WBC count: 10-1000 cells/µL
Classically lymphocytes but may be PMN early

Glucose level: >60% serum glucose (may be low in HSV infection)
Protein level: Elevated (>50 mg/dL)

Question 16

CSF high lymp but low glucose

Answer 16

HSV

Question 17

CSF low glucose

Answer 17

1. mumps is unusual in being associated with a low glucose level in a proportion of cases.
2. herpes encephalitis

Question 18

raised protein levels in CSF

Answer 18

viral encephalitis
tuberculous, fungal and bacterial meningitis
Guillain-Barre syndrome
Froin’s syndrome*

Question 19

Bloody diarrhoea

Answer 19

1. Shigella rx Ciprofloxacin
2. Salmonella (non-typhoid)rx Ciprofloxacin
3. Campylobacter- RX clari
4. E. coli
5. Amoebiasis-metronidazole and tinidazole

Question 20

Diff btwn Clostridium botulinum and Clostridium tetani

Answer 20

• Clostridium botulinum presents with flaccid paralysis,
  whereas
  Clostridium tetani presents with spastic paralysis

Question 21

Rx First episode of C. Diff

Answer 21

1st-line therapy: oral vancomycin for 10 days

2nd-line therapy: oral fidaxomicin

3rd-line therapy: oral vancomycin +/- IV metronidazole

Question 22

Rx Recurrent episode
- Within 12 weeks of symptom resolution
-After 12 weeks of symptom resolution

Answer 22

Within 12 weeks of symptom resolution: oral fidaxomicin

After 12 weeks of symptom resolution:
oral vancomycin OR fidaxomicin

faecal microbiota transplant- considered for pts W/ 2 or >2 episodes

Question 23

Life-threatening C. difficile infection

Answer 23

vancomycin &IV metronidazole
specialist advice - surgery may be considered

bezlotoxumab is a monoclonal antibody which targets C. difficile toxin B

Question 24

What causes?
malabsorption: diarrhoea, weight loss

large-joint arthralgia

lymphadenopathy

skin: hyperpigmentation & photosensitivity

pleurisy, pericarditis
May have neur sx
Name IX, HLA ass, Rx

Answer 24

Whipple’s disease is a rare multi-system disorder caused by Tropheryma whippelii infection. It is more common in those who are HLA-B27 positive and in middle-aged men.

jejunal biopsy shows deposition of macrophages containing Periodic acid-Schiff (PAS) granules

Rx: co-trimoxazole

Question 25

Screening for latent tuberculosis

Answer 25

Mantoux test is the main technique used to screen for latent tuberculosis. In recent years the interferon-gamma blood test

Question 26

What leads to false -ve Mantoux test

Answer 26

False negative tests may be caused by: miliary TB sarcoidosis HIV lymphoma very young age (e.g. < 6 months) *Missed lump*

Question 27

Diagnosis of active tuberculosis

Answer 27

1. Chest x-ray upper lobe cavitation is the classical finding of reactivated TB bilateral hilar lymphadenopathy 1.**Nucleic acid amplification tests (NAAT)** allows rapid diagnosis (within 24-48 hours) more sensitive than smear but less sensitive than culture 2. **Sputum smear**- Need 3 specimens; presence of acid-fast bacilli (Ziehl-Neelsen stain); rapid & inexpensive test -sensitivity is between 50-80% decreased in HIV to around 20-30% 3. **Sputum culture**- gold standard but can take 1-3 weeks

Question 28

Rx TB

Answer 28

2 months RIPE + 4 Month of RI

Question 29

Rx latent TB

Answer 29

3 months RIP isoniazid (with pyridoxine) and rifampicin OR 6 months of PI isoniazid (with pyridoxine)

Question 30

Rx meningeal tuberculosis

Answer 30

at least 12 months with the addition of steroids

Question 31

What is Immune reconstitution disease

Answer 31

Sx, Lab & imaging get worse with initial rx occurs typically 3-6 weeks after starting treatment often presents with enlarging lymph nodes

Question 32

What should always be prescribed with Isoniazid

Answer 32

isoniazid causes peripheral neuropathy, and pyridoxine (vitamin B6) is co-prescribed to help prevent this (“I’m-so-numb-azid”).

Question 33

MOA & SE Isoniazid

Answer 33

* MOA: inhibits mycolic acid synthesis * **peripheral neuropathy**: prevent with **pyridoxine** (Vitamin B6) * hepatitis, agranulocytosis * liver enzyme inhibitor * drug-induced lupus

Question 34

MOA & SE Pyrazinamide

Answer 34

Pyrazinamide * moa: converted by pyrazinamidase into pyrazinoic acid --> inhibits fatty acid synthase (FAS) * hyperuricaemia causing gout * arthralgia, myalgia * hepatitis

Question 35

MOA & SE: Ethambutol

Answer 35

Ethambutol * MOA : inhibits the enzyme arabinosyl transferase which polymerizes arabinose into arabinan * optic neuritis: check visual acuity before & during RX * dose needs adjusting in patients with renal impairment

Question 36

MOA & SE: Rifampicin

Answer 36

* MOA: inhibits bacterial DNA dependent RNA polymerase preventing transcription of DNA into mRNA * potent liver enzyme inducer * hepatitis, orange secretions * flu-like symptoms

Question 37

CSF in TB

Answer 37

Slight cloudy, fibrin web Glucose: Low (< 1/2 plasma) Protein High (> 1 g/l)

Question 38

Live attenuated vaccines cant be given to the immocompirmised which are they

Answer 38

Live attenuated vaccines BCG MMR oral polio yellow fever oral typhoid

Question 39

Gram-positive cocci

Answer 39

staphylococci + streptococci (including enterococci)

Question 40

Gram-negative cocci

Answer 40

= Neisseria meningitidis + Neisseria gonorrhoeae, also Moraxella catarrhalis

Question 41

Gram-positive rods (bacilli)

Answer 41

ABCD L Actinomyces Bacillus anthracis (anthrax) Clostridium Diphtheria: Corynebacterium diphtheriae Listeria monocytogenes

Question 42

Abx : Inhibits cell wall formation peptidoglycan cross-linking:

Answer 42

penicillins, cephalosporins-( cephalexin, cefuroxime ceftriaxone carbopenems (Meropenem.)

Question 43

Abx : Inhibits cell wall formation peptidoglycan synthesis:

Answer 43

peptidoglycan synthesis: glycopeptides (e.g. vancomycin)

Question 44

ABX Inhibits protein synthesis by acting on the ribosome 50S subunit:

Answer 44

macrolides, chloramphenicol, clindamycin, linezolid, streptogrammins

Question 45

ABX Inhibits protein synthesis by acting on the ribosome 50S subunit:

Answer 45

aminoglycosides, tetracyclines

Question 46

Abx inhibits DNA synthesis

Answer 46

quinolones (e.g. ciprofloxacin)

Question 47

Abxs Damages DNA

Answer 47

metronidazole

Question 48

Abxs Inhibits folic acid formation

Answer 48

Inhibits folic acid formation sulphonamides trimethoprim

Question 49

abs Inhibits RNA synthesis

Answer 49

rifampicin