Infectious diseases

Question 1

What is bacterial vaginosis?

Answer 1

a bacterial imbalance of the vagina caused by an overgrowth of anaerobic bacteria and a loss of lactobacilli.

Question 2

Features of bacterial vaginosis?

Answer 2

Increased vaginal discharge
Grey-white watery discharge
Characteristic “fishy” smelling discharge, particularly after intercourse

Question 3

Diganosis of bacterial vaginosis?

Answer 3

In order to diagnose bacterial vaginosis, the Amstel criteria are often used. Three out of four features are needed to confer a diagnosis:

Vaginal pH >4.5
Homogenous grey or milky discharge
Positive whiff test (addition of 10% potassium hydroxide produces fishy odour)
Clue cells present on wet mount

Question 4

Management of bacterial vaginosis?

Answer 4

The treatment of choice is usually either Metronidazole or Clindamycin, which can be administered orally or intravaginall

Question 5

Risk factors for cellulitis?

Answer 5

Advancing age
Immunocompromised e.g. diabetic
Predisposing skin condition e.g. ulcers, pressure sores, trauma, lymphoedema

Question 6

Management of cellulitis?

Answer 6

Blood tests including culture
Skin swab for culture
Oral or IV antibiotics depending on severity
Mark the area of erythema to aid in detection of rapidly spreading cellulitis
Elevate if possible
Wound debridement may be necessary

Question 7

Cholera- what is it?

Answer 7

acute, secretory diarrhoea caused by infection with Vibrio cholerae of the O1 and O139 serogroups. Cholera is endemic in over 50 countries and also causes large epidemics.

Although mild cholera may be indistinguishable from other diarrheal illnesses, the presentation of severe cholera is distinct, with dramatic diarrheal purging.

Question 8

Features of cholera?

Answer 8

Watery diarrhoea that begins suddenly
Abdominal cramps
Nausea
Vomiting
Excessive thirst
Dry mouth
Dry skin
Oliguria
Drowsiness or lethargy
Irritability

Question 9

Management of cholera?

Answer 9

Aggressive fluid replacement: effective therapy can decrease mortality from over 50% to less than 0.2%.

Antibiotics (Doxycycline or co-trimoxazole) decrease volume and duration of diarrhoea by 50% and are recommended for patients with moderate to severe dehydration.

Question 10

What is clostridum difficle?

Answer 10

am positive bacteria that causes pseudomembranous colitis, commonly seen in patients who have recently been on a course of broad spectrum antibiotics.

The microorganism produces toxins that cause inflammation, diarrhoea, and the development of a ‘pseudomembrane’ in the large bowel.

Question 11

Risk factors for developing clostridium difficile?

Answer 11

Have been treated with broad-spectrum antibiotics
Common antibiotic risk factors include:
Clindamycin
Ciprofloxacin
Cephalosporins
Penicillins
Have had to stay in a healthcare setting, such as a hospital or care home, for a long time
Are over 65 years old
Have certain underlying conditions, including inflammatory bowel disease (IBD), cancer, or kidney disease
Have a weak immune system, as a result of conditions such as diabetes or HIV infection or as side effect of a treatment such as chemotherapy or steroid medication
Are taking a proton pump inhibitor (PPI)

Question 12

Clinical features of clostridium difficile infection

Answer 12

Infection presents as a wide range of clinical disease, ranging from asymptomatic colonisation or trivial diarrhoea to life threatening illness. The most common symptoms and signs of CDI are:

Watery diarrhoea, which can be bloody
Painful abdominal cramps
Nausea
Signs of dehydration, such as dry mucous membranes, tachycardia and oliguria
Fever
Loss of appetite and weight loss
Confusion

Question 13

Management of clostrium difficle?

Answer 13

PO vancomycin

Question 14

Scarlet fever features

Answer 14

Due to erythrogenic toxin, causing fever, desquamating rash and a ‘strawberry’ tongue often accompanied by abdominal pain and vomiting

Question 15

What does HsaAg positive indicate
What does AntiHsB positive indicate
What does Anti HBc positive indicate

Answer 15

HBsAg implies acute disease if present for 1-6 months and if more than 6 months = chronic
( also igM = acute, IgG= chronic)

Anti HBs= immunity

Anti HBc= previous or current infection .. c - caught= negative if immunised

Question 16

What to give to a newborn baby whos mother tests positive for hep B

Answer 16

Hep B vacine adn 0.5 mm of HBIG
Vacccine at 1-2 months
Vaccine at 6 months

Question 17

alcohol - is alt or ast higher

Answer 17

ast is higher

Question 18

Samonella treatmetn

Answer 18

Cirofloxacin

Question 19

Watery stools, crams an dnausea
TRAVELLER

Answer 19

E coli

Question 20

Gradual onset bloody diarrhoea. abdo pain and tenderness that may last for several weeks

Answer 20

Amoebiases

Question 21

Flu like prodome, followed by crampy abdo pain, fever and diarrhoea which may be bloody

Answer 21

Campylobacter

Question 22

Hep B features

Answer 22

Fever, jaundice, elevated LFTs

Question 23

Complications of hep B infection?

Answer 23

chronic hepatitis (5-10%). ‘Ground-glass’ hepatocytes may be seen on light microscopy
fulminant liver failure (1%)
hepatocellular carcinoma
glomerulonephritis
polyarteritis nodosa
cryoglobulinaemia

Question 24

Hep B - hows it spread?

Answer 24

infected blood or body fluids, including vertical transmission from mother to child.

Question 25

Hep A features

Answer 25

flu-like prodrome abdominal pain: typically right upper quadrant tender hepatomegaly jaundice deranged liver function tests

Question 26

Hep A hows it spread

Answer 26

Faecal oral

Question 27

Hep C - hows it spread?

Answer 27

IV drug users Blood NO VACCINE

Question 28

Meningitis management?

Answer 28

IV ceftriaxone for bacterial IV aciclovir if viral

Question 29

Current notifiable disease

Answer 29

Acute encephalitis Acute infectious hepatitis Acute meningitis Acute poliomyelitis Anthrax Botulism Brucellosis Cholera COVID-19 Diphtheria Enteric fever (typhoid or paratyphoid fever) Food poisoning Haemolytic uraemic syndrome (HUS) Infectious bloody diarrhoea Invasive group A streptococcal disease Legionnaires Disease Leprosy Malaria Measles Meningococcal septicaemia Mumps Plague Rabies Rubella Severe Acute Respiratory Syndrome (SARS) Scarlet fever Smallpox Tetanus Tuberculosis Typhus Viral haemorrhagic fever (VHF) Whooping cough Yellow fever

Question 30

SBP treatment

Answer 30

Piperacillin/Tazobactam (Tazocin) is often first line

Question 31

Staph infections

Answer 31

Fluclox