MSRA > Micro > Flashcards

Micro Flashcards

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1
Q

Tx of Lyme disease

A

Borrelia burgdorferi
21d of doxy

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2
Q

Mx of vaginal thrush

A

1st line: Fluconazole 150mg PO stat

Alt: Clotrimazole 500mg pessary

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3
Q

Tx of BV

A

Metronidazole
Even in pregnancy

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4
Q

Antivirals in shingles

A

in practice, they recommend antivirals within 72 hours for the majority of patients, unless the patient is < 50 years and has a ‘mild’ truncal rash associated with mild pain and no underlying risk factors

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5
Q

Mx of erythematous, scaly patches on the nasolabial folds, eyebrows and upper chest.

A

Topical ketoconazole
Seb derm

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6
Q

What virus causes kaposi sarcoma

A

HHV8

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7
Q

Organism causing otitis media

A

H influenza

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8
Q

Live vaccines that can’t be given to immunocompromised

A

BCG
measles, mumps, rubella (MMR)
influenza (intranasal)
oral rotavirus
oral polio
yellow fever
oral typhoid

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9
Q

Features of cholera

A

profuse ‘rice water’ diarrhoea
dehydration
hypoglycaemia

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10
Q

Mx of cholera

A

Rehydration
Antibiotics are not routinely required for all cholera cases but are indicated in moderate to severe disease to reduce the duration of diarrhoea and bacterial shedding.- cipro/doxy

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11
Q

Mx of whooping cough

A

an oral macrolide (e.g. clarithromycin, azithromycin or erythromycin) is indicated if the onset of the cough is within the previous 21 days to eradicate the organism and reduce the spread

Clarithromycin: 7 days
Azithromycin: 3 days (shorter course)
Erythromycin: 7 days

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12
Q

Organism causing peritonitis in dialysis

A

Coagulase-negative Staphylococcus is the most common cause of peritonitis secondary to peritoneal dialysis

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13
Q

When to refer to coroner

A
  1. Unnatural deaths - including accidents, suicides, homicides, or deaths where there is suspicion of violence or neglect
  2. Unknown cause of death - where the medical practitioner is unable to determine the cause
  3. Industrial disease deaths - including asbestos-related conditions such as mesothelioma or asbestosis (as in this case)
  4. Deaths occurring during or shortly after surgical procedures or anaesthesia
  5. Deaths in custody or state detention (prisons, police custody, immigration detention)
  6. Deaths where the deceased was not seen by the certifying doctor either after death or within 14 days before death
  7. Deaths potentially related to medical treatment or care (iatrogenic causes)
  8. Deaths where the deceased did not have a GP or was not seen by their GP in the 28 days before death
  9. Deaths occurring within 24 hours of hospital admission
  10. Deaths potentially related to notifiable infectious diseases
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14
Q

When to give tetanus booster and TIG

A

If the patient’s tetanus vaccination history is unknown or incomplete, give tetanus immunoglobulin (TIG) plus a vaccine booster for any tetanus-prone or high-risk wound.
If the patient has had a full course of vaccination but the last dose was >10 years ago, give TIG plus a vaccine booster only for high-risk wounds.
If the last vaccine dose was <10 years ago, no TIG is needed regardless of wound type.

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15
Q

Test for HIV

A

Detects p24 antigen + HIV-1/2 IgM/IgG antibodies

Window period ~45 days (most detectable by 18–24 days)

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16
Q

Mx of patient being bitten by tick, but asymptomatic

A

No treatment but monitor symptoms

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17
Q

Hep B blood test after vaccine and results meaning

A

Anti-HBs level
> 100 Indicates adequate response, no further testing required. Should still receive booster at 5 years

10 - 100 Suboptimal response - one additional vaccine dose should be given. If immunocompetent no further testing is required

< 10 Non-responder. Test for current or past infection. Give further vaccine course (i.e. 3 doses again) with testing following. If still fails to respond then HBIG would be required for protection if exposed to the virus

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18
Q

Mx of patient with Anti-Toxoplasmosa IgG- Positive
Anti-Toxoplasmosa IgM- Positive

A

Nothing if immunocompetent
Pyrimethamine and sulphadiazine are management options for immunocompromised patients.

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19
Q

What is given to contacts of meningococcal meningitis

A

Oral ciprofloxacin or rifampicin is used as prophylaxis for contacts of patients with meningococcal meningitis

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20
Q

Antibiotics for different meningitis

A

3 months - 60 years: BNF recommends ceftriaxone
≥60 years: BNF recommends ceftriaxone + amoxicillin (or ampicillin) for adults

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21
Q

How often should sickle cell patients receive pneumococcal vaccine

A

Every 5 years

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22
Q

Mx of onchomyositis

A

Oral terbinafine

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23
Q

Diagnosis - yeast and a capsule in the CSF stained with India ink.

A

Cryptococcus

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24
Q

Post exposure prophylaxis Hep A

A

hepatitis A vaccine is preferred for post-exposure prophylaxis

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25
Post exposure prophylaxis Hep B
HBsAg positive source Known responder (anti-HBs ≥10 mIU/mL following full vaccination), a booster dose should be given If they are a non-responder -hepatitis B immunoglobulin (HBIG) and a booster vaccine Unknown source For known responders, a booster dose For non-responders, HBIG and a booster vaccine Individuals undergoing a primary course of vaccination should complete an accelerated schedule and may be offered HBIG if the risk of exposure is considered high
26
Mx of enteric fever
Cipro
27
Sx of typhoid
relative bradycardia abdominal pain, distension constipation: although Salmonella is a recognised cause of diarrhoea, constipation is more common in typhoid rose spots
28
Who is offered HPV vaccine
Boys and girls aged 12-13
29
Organisms causing meningitis in children
Neonatal to 3 months Group B Streptococcus: usually acquired from the mother at birth. More common in low birth weight babies and following prolonged rupture of the membranes E. coli and other Gram -ve organisms Listeria monocytogenes 1 month to 6 years Neisseria meningitidis (meningococcus) Streptococcus pneumoniae (pneumococcus) Haemophilus influenzae Greater than 6 years Neisseria meningitidis (meningococcus) Streptococcus pneumoniae (pneumococcus)
30
Organsim causing bone infections in sickle cell patients
Non typhi salmonella
31
Mx of latent TB
3 months of isoniazid (with pyridoxine) and rifampicin, or 6 months of isoniazid (with pyridoxine)
32
When can you no longer offer rotavirus vaccine
After 15 weeks- due to causing intersuseption
33
Best method to assess response to hep C treatment
Viral load
34
Vaccines to avoid whilst on azathioprine
Live attenuated
35
List live attenuated vaccines
Babies Make Immune Responses Protecting Young Tots” BCG Measles Mumps Rubella Influenza (nasal) Rotavirus oral Polio oral Yellow fever Typhoid oral
36
Mx of C diff
first-line therapy is oral vancomycin for 10 days second-line therapy: oral fidaxomicin third-line therapy: oral vancomycin +/- IV metronidazole Life-threatening C. difficile infection oral vancomycin AND IV metronidazole specialist advice - surgery may be considered
37
How C jejuni infections present
prodrome, abdominal pain and bloody diarrhoea
38
Mx of this Examination with a Wood's light demonstrates yellow-green fluorescence
Ketoconazole shampoo for P versicolor
39
Investigations for HIV
Initial test: Perform a combined HIV p24 antigen and antibody test at 4 weeks post-exposure. Repeat test: If the initial test is negative and the patient remains asymptomatic, offer a repeat combined test at 12 weeks (3 months) p . Early symptomatic testing: In patients presenting with symptoms suggestive of acute HIV seroconversion illness (typically 3-12 weeks after exposure), consider testing earlier
40
Mx of Pneumocystis jiroveci pneumonia
Co tirm
41
Antibiotic that causes macrocytic anaemia
Trimethoprim for inhibiting folate
42
Management of Post-exposure prophylaxis for HIV
oral antiretroviral therapy for 4 weeks HIV serological testing is required at 12 weeks after completing PEP
43
Latest PEP can be given after exposure
72 hrs
44
When are you not required to give tetanus booster or IG
If a patient has had 5 doses of tetanus vaccine, with the last dose < 10 years ago, they don't require a booster vaccine nor immunoglobulins, regardless of how severe the wound is
45
First and second line of scabies
permethrin 5% is first-line malathion 0.5% is second-line
46
When to retreat scabies
itching can persist for up to 6 weeks after successful treatment due to a delayed hypersensitivity reaction to the mites, even if all the mites have been killed. Retreatment should only be considered if new burrows or rashes appear, or if living mites are found upon examination.
47
Diagnosing BV
(diagnosis if ≥3/4) Vaginal pH > 4.5 Positive whiff test (fishy odour with 10% KOH) Clue cells > 20% Thin, homogenous discharge
48
Abx for BV
1st line: Metronidazole 400mg BD for 7 days Alt: Metronidazole 2g stat (not in pregnancy)
49
When is thrush recurrent and mx
≥4 episodes/year Confirm with high vaginal swab Managemen Induction: Fluconazole every 3 days (x3 doses) Maintenance: Fluconazole weekly for 6 months
50
Ix for chlamydia
Send samples for NAATs (nucleic acid amplification tests) Women: Vulvovaginal swab Men: First catch urine
51
Mx of chlamydia
1st line: Doxycycline 100mg BD x 7 days 2nd line (or pregnancy): Azithromycin
52
Stages of LV
Stage 1: painless ulcer, bloody anorectal discharge, tenesmus Stage 2: painful inguinal lymphadenopathy Stage 3: fibrosis, strictures, fistulae
53
Mx of gonorrhoea
If sensitivities known: Ciprofloxacin If unknown: Ceftriaxone 1g IM stat Alternative e.g. needle phobia: Cefixime + Azithromycin or Gentamicin + Azithromycin
54
Partner notification of gonnorhoea
Men with urethritis - partners within 2 weeks, or most recent partner only if > 2 weeks ago Women and asymptomatic men - partners within 3 months
55
Treating urethritis in men
Empirical doxycycline 100mg BD x 7 days NAAT and swabs
56
Cutaneous TB sx
Lupus vulgaris (most common skin form) — flat red plaques that ulcerate Erythema nodosum
57
+ve Mantoux Test
≥5mm = positive
58
Mx of CNS TB
12-month extended RIPE treatment Add corticosteroids for 4–8 weeks
59
Complications of TB treatment
Rifampicin: Hepatitis Orange urine Potent enzyme inducer Isoniazid: Peripheral neuropathy (prevent with pyridoxine) Agranulocytosis Pyrazinamide: Hyperuricaemia → gout Ethambutol: Optic neuritis → red-green colour blindness
60
Endocarditis abx
Native Valve Amoxicillin + gentamicin PA/MSRA: Vancomycin + gentamicin Prosthetic Valve Vancomycin + rifampicin + gentamicin
61
Meningitis (Empirical Therapy)
Age 3 months – 59 years Cefotaxime or ceftriaxone Age < 3 months or Age ≥60 Cefotaxime + amoxicillin
62
Neutropenic Sepsis mx
1st line: Piperacillin–tazobactam
63
Mx of campylobacter, salmonella, shigella
Campylobacter If severe/immunocompromised: Clarithromycin Salmonella Non-typhoid: Ciprofloxacin or cefotaxime Typhoid fever: Cefotaxime or ceftriaxone Shigella If severe: Ciprofloxacin or azithromycin
64
Abx for diverticulitis and biliary
Diverticulitis Co-amoxiclav PA: Metronidazole + cefalexin or trimethoprim Biliary Infection Ciprofloxacin OR gentamicin OR cephalosporin
65
Abx for acute sinusitis
1st line: Phenoxymethylpenicillin If severe: Co-amoxiclav PA: Doxycycline or clarithromycin
66
Abx for osteomyelitis and septic arthritis
🦴 Osteomyelitis 1st line: Flucloxacillin PA: Clindamycin MRSA: Vancomycin 🦵 Septic Arthritis 1st line: Flucloxacillin PA: Clindamycin Gonococcal/Gram -ve: Cefotaxime
67
Mx of periodontal abscess and gingivitis
Periodontal Abscess Phenoxymethylpenicillin Gingivitis Metronidazole
68
Mx of confirmed HIV
Triple therapy = 2 NRTIs + 1 INI/NNRTI/PI NRTIs Emtricitabine + tenofovir Abacavir + lamivudine SEs: Peripheral neuropathy NNRTIs (end in -virine) Nevirapine, efavirenz PIs (end in -navir) Idinavir, nelfinavir SEs: Metabolic syndrome INIs (end in -tegravir) Raltegravir, dolutegravir
69
Mx of syphillis
Intramuscular benzathine benzylpenicillin Jarisch-Herxheimer reaction Acute flu-like illness after treatment
70
Phases of syphillis
Primary syphilis Painless chancre: single, firm, indurated ulcer with well-defined margins Regional lymphadenopathy Secondary syphilis Generalised lymphadenopathy Fever, lethargy Snail track ulcers (oral mucosa) Condylomata lata (wart-like perianal/genital lesions) Maculopapular rash: may affect palms and soles Tertiary syphilis Gummatous disease: locally destructive plaques/nodules Neurosyphilis: tabes dorsalis, dementia Cardiovascular: aortic aneurysm, aortic regurgitation
71
Thick, yellow discharge, post-coital bleeding, intermenstrual bleeding, and deep dyspareunia.
Chlamydia
72
Most common bacterial cause of meningitis in adults
Streptococcus pneumoniae
73
Polymorphs on LP
Bacterial infection
74
Mx of PID
IM ceftriaxone + PO doxycycline + PO metronidazole for 14 days Alt PO ofloxacin + metronidazole for 14 days PO moxifloxacin for 14 days (esp. if M. genitalium)
75
She attends with multiple purplish nodules on her legs. They were initially painless, but have recently become ulcerated and painful.
Kaposi Sarcoma
76
Management of Falciparum Malaria
Uncomplicated - 1st Line: PO Artemether-lumefantrine. Complicated/severe - 1st Line for severe: IV Artesunate
77
When is malaria classed as severe
Severe disease is suggested by parasitaemia > 2%, schizonts, cerebral signs, acidosis, hypoglycaemia, Hb < 80, jaundice etc.
78
Ix for malaria
Gold standard diagnosis: thick and thin blood films
79
Mx of Non-Falciparum Malaria
1st line: Artemether-lumefantrine Relapse Prevention (Vivax/Ovale) Primaquine for 14 days
80
Mx of prostatitis
Cipro- 14d
81
small, itchy bump with surrounding redness. He states that after a few days, the lump blistered and ulcerated. skin ulcer, with a central black eschar. Dx and mx
Anthrax Cipro
82
Test for resolution of syphillis
Treponemal +, RPR – = treated syphilis
83
Mx of cellulitis near eyes or nose
1st Line: co-amoxiclav
84
Organism causing threadworm
Enterobius vermicularis
85
Features of ascaris lumbridoides
Abdominal pain, distension, nausea, altered bowel habit, malabsorption. Loeffler’s syndrome (eosinophilic pneumonitis): cough, fever, wheeze, SOB. Urticarial rash from skin migration of larvae. Eosinophilia + travel + pulmonary symptoms → think Ascaris
86
Mx of Ascaris lumbricoides
1st line: Single dose of mebendazole.
87
HIV with chronic diarrhoea
Cryptosporidiosis
88
Test for Cryptosporidiosis in stool
Stool: Ziehl-Neelsen stain → red cysts
89
Rapid diagnostic test for malaria
HRP2 or pLDH antigen
90
Dengue fever
Causes retro-orbital pain, rash, and thrombocytopenia Facial flushing Haemorrhagic signs
91
Chikungunya
Sudden onset high-grade fever Severe joint pain, typically symmetric and affecting wrists, knees, ankles, and small joints of the hands
92
Zika Virus
Often mild or asymptomatic Fever, conjunctivitis, rash, headache, myalgia Vertical transmission in pregnancy can lead to microcephaly, intracranial calcifications, and other birth defects
93
Mx of gonorrhoea
IM Cef
94
Common wart features
Rough, raised, cauliflower-like papules Hyperkeratotic surface
95
Plantar Warts (Verrucae) features
Location: soles of the feet (can also appear on palms) Often painful when walking or under pressure Central black dots (thrombosed capillaries)
96
Filiform Warts features
Narrow, thread-like projections (finger-like fronds) Often on the face (eyelids, lips, neck)
97
White plaques on lateral borders of tongue, with corrugated/folded appearance, and hair from within folds. Cannot be removed with oral care.
Hairy leukoplakia
98
Most common organism causing meningitis in young adults
Neisseria meningitidis
99
Mx of enteric fever
1st Line: IV cefotaxime or ceftriaxone
100
Botulism features
Symmetric, descending flaccid paralysis
101
Leprosy features
Skin changes: hypopigmentation or hyperpigmentation, dry and flaky Sensory loss of affected skin → injury risk Peripheral nerve involvement: paralysis (hands/feet)
102
Leptospirosis features
Risk: sewage workers, farmers, vets 👀 Clinical Features Sudden-onset fever, myalgia, headache Calf tenderness Conjunctival suffusion
103
Mx of lepto
Mild: Doxycycline Severe: IV benzylpenicillin or ceftriaxone
104
HIV shortness of breath. Gomori methenamine silver staining of bronchoalveolar lavage fluid is positive.
Pneumocystis jirovecii pneumonia (PJP) COtrim
105
Ix of threadworm
Investigations: Sticky tape test for microscopy
106
Immunodeficient with CT head shows multiple ring enhancing lesions.
cerebral toxoplasmosis.
107
Mx of meningeal crypto
Amphotericin B + flucytosine, then fluconazole
108
Mx of MRSA on swab
Skin decolonisation: Chlorhexidine gluconate 4% solution Use OD as body wash and shampoo on Days 1 and 3 Total duration: 5 days Nasal decolonisation: Mupirocin 2% nasal ointment Apply TDS for 5 days
109
Abdominal pain, distension, and a linear, urticarial rash, following travel to South East Asia, along with eosinophilia
Helminth migration
110
Itching in the genital region, which is even worse at night. On examination, there are numerous tiny white dots within her pubic hair, each the size of a pinhead, and multiple blue/red papules on the surrounding skin.
Permethrin for lice
111
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