4.11 Infectious Disorders

Front 1

Causative organisms associated with pleural

effusion and pneumonia on CXR:

Back 1

1. Chlamydial sp.
2. Legionella sp.
3. TB
4. Pyogenic organisms
5. Anaerobic organisms.

Front 2

Blood cultures in pneumonia - which patients?

Back 2

1. Immunocompromised
2. Severe sepsis / shock
3. Risk factors for endovascular infection:
a. prosthetic valves
b. IVDU
c. cavitary infiltrates

Front 3

High risk-group patients for Tuberculosis?

Back 3

1. Homelessness
2. IVDU
3. Alcoholism
4. HIV

Front 4

High risk History for TB?

Back 4

1. High risk group
a. Homeless
b. IVDU
c. Alcoholism
d. HIV
2. Symptoms
a. Weight loss
b. Night sweats
c. Haemoptysis
d. Persistent cough
3. Previous TB exposure

Front 5

Broad categories for Choice of emperical

antibiotic cover in pneumonia?

Back 5

1. Epidemiological
2. Clinical
3. laboratory
4. Radiologic

Front 6

Disease associations with Streptococcus

pneumoniae: {8}

Back 6

1. Splenectomy
2. Sickle cell disease
3. Alcoholism
4. malignancy
5. Immunosuppression
6. Cardiovascular disease
7. Age > 65
8. Diabetes

Front 7

Disease associations with Haemophilus

pneumoniae ? {5}

Back 7

1. COPD
2. Diabetes
3. Alcoholism
4. Malignancy
5. Malnutrition

Front 8

Epidemiological clues for aetiology of

pneumonia:
1. Bird handling [turkey/duck/chicken/exotic]
2. Bird exposure in Avian flu countries {Asia}
3. Handling cattle/sheep/goats/parturient cats
4. Handling infected wool
5. Insect bite -transmission from rodents/wild animals {rabbits}
6. Insect bites / scratches from infected rodents
7. Exposure to mice/mice droppings

Back 8

1. Chlamydophila psittaci
2. Influenza A H5N1 {SARS}
3. Coxiella burnetti {Q fever}
4. Bacillus anthracis {Anthrax}
5. Francisella tularensis {Tulareamia}
6. Yersina pestis {Plague}
7. Hanta virus

Front 9

Epidemiological factors for Legionella

pneumoniae {3}

Back 9

1. Air conditioning cooling towers
2. Hot tubs
3. Hotel / Cruise ship stay within two weeks

Front 10

Pneumonia in the IVDU : causative organisms ? {4}

Back 10

1. S aureus
2. S pneumoniae
3. Anaerobes
4. Mycobacterium TB.

Front 11

Pneumonia in the Alcoholic- causative organisms ? { 6 }

Back 11

1. S pneumoniae
2. S aureus
3. Klebsiella pn.
4. Oral Anaerobes
5. Mycobacterium TB
6. Acinetobacter sp.

Front 12

Pneumonia in the COPD / smoker -causative organisms {6}

Back 12

1. S pneumoniae
2. H influenzae
3. Moraxella catarrhalis
4. Chlamydophila pn.
5. Legionella sp.
6. Pseudomonas aeruginosa

Front 13

Pneumonia severe enough to necessitate intubation-ventilation -causative organisms ? {9}

Back 13

1. S pneumoniae
2. S aureus
3. H influenzae
4. Mycoplasma pn.
5. Legionella sp.
6. Chlamydophila pn.
7. Mycobacterium TB
8. Viral infection - Influenza
9. Enteric gram negative bacilli

Front 14

Pneumonia associated with structural lung disease -causative organisms ? {3}

Back 14

1. Pseudomonas aeruginosa
2. Burkholderia cepacia
3. S aureus

Front 15

Lung abscess-causative organisms ? { 5 }

Back 15

1. CA-MRSA
2. Oral Anaerobes
3. Mycobacterium TB
4. Atypical mycobacteria
5. Endemic fungi

Front 16

Pneumonia + pleural effusion -causative organisms ? {6 }

Back 16

1. S aureus
2. S pneumoniae
3. Chlamydophila sp.
4. Legionella sp.
5. Mycobacterium TB
6. Anaerobes

Front 17

Stats for Elderly patients with pneumonia:
1. 50% have non respiratory symptoms
2. 33% have no systemic signs of infection

Back 17

Overall, the "Classic Signs" of consolidation in patients {adults} occur in < 25%

Front 18

Which is incorrect regarding Urinary Antigen testing?
1. Legionella Test is specific {>95%}
2. Legionella Test is sensitive {90-100%}
3. A negative Legionella result does not exclude Legionella infection
4. L pneumophilia serogroup 2 is the most commonly reported cause of L pneumonia.
5. Pneumococcal Antigen is only 50-80% sensitive , but has high specificity {>90%}.

Back 18

4. L pneumophilia serogroup 1

Front 19

Risk factors for Pseudomonas pneumonia ? {5}

Back 19

1. COPD / Bronchiectasis
2. Recent Hospitalisation
3. Recent antimicrobial therapy
4. Neutropenia
5. Gross aspiration

Front 20

Important tests on pleural fluid in suspected pneumonia + pleural effusion? { }
[ note-always know what tests and tubes are required prior to aspiration ]

Back 20

1. FBC + Differential
2. Biochemistry
3. Gram stain and culture
4. pH
5. TB tests
a. ADA
{ adenosine deaminase}
b. Gamma interferon
c. PCR
N.B. Collect more fluid than anticipated {multiple containers}
{ See Side 3}

Hint 20

1. FBC
- RBC
- WBC
- Neutrophils {acute}
- Lymphocytes {Chronic}
2. Biochemistry =
- LDH
- protein
3. Gram stain
Culture {direct into bottles}
4. pH into gas syringe
5. Check with lab what tubes/containers are required.

Front 21

PLeural fluid analysis in pneumonia and pleural effusion: Transudate vs exudate - Light's Criteria ?

Back 21

Exudate =
1. protein ratio of pleural fluid -to-serum > 0.5
2. LDH ratio of pleural fluid-to-serum >0.6
3. LDH level pleural fluid > 2/3 upper limit of serum reference range

Front 22

Presence of bloody pleural effusion - [ > 100,000 cells/mm] causes? { }

Back 22

1. Trauma
2. pneumonia
3. malignancy
4. pulmonary infarct

Front 23

Which of the following is incorrect regarding pleural fluid aspiration?
1. the glucose concentration is variable, and does not correlate with a specific disease process
2. A pleural fluid ADA level above 40 U/L is highly suggestive for TB
3. pleural pH > 7.2 indicates pleural inflammation
4. A predominance of neutrophils on the differential is suggestive of an acute pleural process such as infection
5. As well as blood culture bottles, Standard Specimen Containers and Haematology/Biochemistry tubes, a Gas Syringe should be available for fluid analysis.

Back 23

3. pleural pH < 7.3 indicates pleural inflammation

Front 24

Which is incorrect with PJP {pneumocystis
jiroveci }pneumonia?
1. Most cases occur in untreated HIV patients or in those with advanced immunosuppression
2. chest crackles on auscultation are rare
3. The initial CXR is normal in 10%
4. pleural effusions / lymphadenopathy are not uncommon on CXR
5. bronchoscopy + lavage is diagnostic in 90% cases.

Back 24

4. pleural effusions and hilar, or mediastinal lymphadenopathy are unusual on CXR in PJP

Front 25

Pneumonia in AIDS-which is incorrect?
1. Bacterial pneumonia is the most common cause of acute respiratory failure.
2. Treatment of PJP is with trimethoprim + sulphamethoxazole {co-trimoxazole} + steroids
3. Legionella is rare.
4. pleural effusions are common in mycobacterial infection
5. sulphamethoxazole is well tolerated

Back 25

5. Side effects are common in HIV patients:
- nausea
- vomiting
- myelotoxicity
- rashes

Front 26

The commonest organisms associated with AIDS pneumonia:?

Back 26

1. Streptococcus pn.
2. Haemophilus influenzae
3. Pseudomonas aeruginosa
4. Staphylococcus aureus

Front 27

TB pattern in HIV and associated T Lymphocyte counts

Back 27

CD4+ T Lymphocytes > 350 cells / uL
= Clinical pattern the same as for non HIV-infected patients

CD4+ count < 350 cells/uL
extrapulmonary disease common :
1. pleuritis
2. pericarditis
3. meningitis

CD4+ count < 100
- rapidly progressive severe systemic disease-sepsis
- lower/middle lobe pneumonia
- miliary disease common
- cavitation less common

Front 28

CMV infection risks {patient types}? {7}

Back 28

1. Allogenic stem cell transplants
2. Lung transplant
3. Pancreas transplant
4. Liver transplant
5. Heart transplant
6. Renal transplant
7. Advanced AIDS

Front 29

In regards to empyema, which is incorrect?
1. It may be associated with malignancy or trauma
2. Anaerobic bacteria are responsible for >75% cases
3. Streptococci are not a causative organism
4. Antibiotics have only an adjunctive role in the treatment of empyema
5. Mainstay of treatment is drainage of the pus { intercostal catheter or Surgically}

Back 29

3. Streptococci and Gram negative rods account for > 75% cases

Front 30

10 Risk factors for TB?

Back 30

1. Immunocompromised
2. Older age
3. Substance abuse
4. Malnutrition
5. Close contact with infected
6. Crowded Living conditions
7. Health/Residential-care work
8. Travel to endemic areas
9. Recent immigration
10. Silicosis

Front 31

TB Stages {3}

Back 31

1. Primary TB
2. Latent TB
3. Active TB -Reactivation

Front 32

Main Extrapulmonary TB types / sites ?
[6]

Back 32

1. Lymph nodes **
2. Pleura
3. Pericardium
4. Meninges
5. Bones/joints
6. Genitourinary tract

Front 33

Initial therapy for Active TB ? [ 4 drugs]

Back 33

1. Isoniazid
2. rifampicin
3. pyrazinamide
4. ethambutol

Front 34

CXR features in late stage HIV with TB? [3]

Back 34

1. Atypical CXR
- less cavitation
- less upper lobe disease
2. Thoracic lymphadenopathy+
3. pleural effusion

Front 35

DDx for Cavitatory pulmonary lesions?

Back 35

1. Active TB
2. {other} infections
a. Staphylococcus
b. Klebsiella
c. Anaerobes
3. Pulmonary infarcts
4. Wegener's Granulomatosis
5. Rheumatoid nodules

Front 36

Bacterial causes of Food poisoning ? { 10 }

Back 36

1. Bacillus cereus
2. Campylobacter jejuni
3. Clostridium perfringens
4. Clostridium botulinum
5. E coli
6. Listeria
7. Salmonella
8. Staphylococcus
9. Shigella
10 Vibrio cholerae

Front 37

Which relationship is incorrect, in regards top food poisoning?
1. Campylobacter - raw poultry
2. shigella - faeces- water
3. E coli -raw vegetables
4. S aureus - seafood
5. Listeria - soft cheeses

Back 37

4. undercooked / raw seafood = - vibrio cholera
- Clostridium botulinum

S aureus =
- cooked meats
- poultry

Front 38

In regards to food poisoning- which relationship is incorrect?
1. unpasteurised milk - Campylobacter jejuni
2. raw / uncooked meats - E coli
3. poultry- listeria
4. rice - Bacillus
5. rice - vibrio cholera

Back 38

5. vibrio = infected/undercooked/raw seafood

Rice = Bacillus cereus

Front 39

Which is incorrect regarding Disseminated Gonococcal disease?
1. It occurs in 2% of patients infected with N gonorrhoeae.
2. Males > females
3. It has 2 stages
4. Tenosynovitis occurs approximately 66% of the time
5. The tender, asymmetric rash is distally located.

Back 39

2. females

2 stages:
1. Primary febrile stage
2. 2nd septic arthritis stage

Front 40

Which is incorrect regarding Disseminated gonococcal Disease {DGD} ?
1. The arthritis-dermatitis syndrome is the most common presentation of DGD
2. The skin lesions usually culture positive for gonococci
3. Fever and migratory polyarthralgias commonly accompany the skin lesions
4. The skin lesions are often multiple , periarticular, and distally placed {hands /feet}.
5. Treatment is for 7 days with a 3rd generation cephalosporin.

Back 40

2. They dont.
Gram stain only occassionally reveals gonococcus.
Immunoflourescent antibody staining of direct smears is more reliable.

Front 41

Which is incorrect regarding gonococcal infection?
1. Gonorrhoea is more common in men.
2. Disseminated gonococcal disease {DGD} is more common in women.
3. Most patients with DGD are concurrently symptomatic with a local genital / oral infection.
4. The classic triad of DGD is migratory polyarthritis + dermatitis + urethritis
5. Assymetric polyarthralgia is the most presenting complaint of DGD.

Back 41

4. Classic triad of DGD is :
migratory polyarthritis
tenosynovitis
dermatitis

Front 42

Which of the following rash-types is not seen in meningococcaemia?

1. petechiae
2. purpura and plaques
3. ecchymosis and purpura fulminans.
4. only 1 and 2
5. 1, 2 and 3.

Back 42

4. All can be seen in meningococcaemia.

Front 43

In regards to the Epidemiology of meningococcaemia, which is incorrect?
1. The main serogroups are A,B,C,Y and W-135
2. The C serotype causes the most outbreaks fo Clinical disease.
3. Cyclical peaks occur every 25 years
4. Disease peaks in Winter
5. Crowded living conditions increase the risk of spread.

Back 43

3. Cyclical peaks every 5-15 yrs

Front 44

Risk factors for developing invasive meningococcal disease? { 9 }

Back 44

1. Crowded living conditions
2. Close contact with infected person
3. Chronic alcohol abuse
4. smoking {active + passive}
5. recent respiratory illness
6. Corticosteroid use
7. Asplenia
8. Complement deficiency
9. Properdin deficiency

Front 45

Microbiological Descriptors for N meningitidis ?

Back 45

- fastidious
- aerobic
- gram negative diplococcus
- encapsulated
- 13 serogroups

Front 46

The 5 patterns of meningococcaemia presentation:

Back 46

1. Occult Bacteraemia { 5%}
2. Meningococcal meningitis
3. Meningococcal septicaemia***
4. Fever and non blanching rash only { 30%}
5. Chronic meningococcaemia {rare 1-2%}

Front 47

What is the most common complication of meningococcaemia?
1. Meningitis
2. Seizures
3. DIC
4. Myocarditis
5. Acute respiratory failure

Back 47

4. myocarditis with CCF or conduction abnormalities

Front 48

12 Poor prognostic indicators in meningococcaemia?

Back 48

1. Extremes of age
2. Seizures
3. NO meningitis
4. Shock
5. Hypothermia
6. Hyperthermia
7. Purpura fulminans
8. WCC < 5
9 Platelets < 100
10. low ESR
11. pH < 7.3
12. petechiae development within 12 hrs of presentation.

Front 49

DDx of meningococccal rash?

Back 49

** Bacteraemia from
- S pneumoniae
- H influenzae
1. Viral exanthem
2. Vasculitis Syndromes
- HSP
- PAN
3. Drug reactions
4. ITP
5. TTP
6. Endocarditis
7. Toxic Shock Syndrome
8. Rocky Mountain Spotted Fever / Typhus / Typhoid fever

Front 50

In regards to Diphtheria, which is incorrect?
1. Caused by endotoxin-producing Corynebacterium diphtheriae.
2. It may involve any mucous membrane
3. The gray inflammatory pseudomembrane classically has a "wet mouse" odour to it.
4. Symptoms include sore throat , weakness, dysarthria and dysphagia.
5. Peripheral neuropathy and myocarditis can also occur.

Back 50

1. exotoxin-producing

Front 51

Which is incorrect regarding Diphtheria?
1. It is treated with penicillin or macrolides.
2. Antitoxin is the mainstay of therapy.
3. Diagnosis is Clinical
4. Diagnosis is confirmed with cultures.
5. All contacts should be given prophylactic antibiotics.

Back 51

All contacts should be given a booster vaccine ADT.
Non immune contacts should be given prophylactic antibiotics after throat swab.

Front 52

Which is incorrect regarding Diphtheriea?
1. It is a gram negative rod.
2. Adults are the at-risk population now
3. Stridor can occur
4. Antitoxin neutralises the exotoxin.
5. Complications include delayed cardiac arrhythmias and proximal extremity muscle weakness.

Back 52

Gram + rod

Front 53

Which is incorrect in regards to Haemophilus influenzae?
1. Gram negative rod
2. Serovar b {Hib} causes most infection in humans.
3. It can cause meningitis
4. It can cause periorbital cellulitis
5. The vaccine is a conjugate vaccine: Hib

Back 53

All are correct.

Front 54

The main disease caused by Haemophilus influenzae?

Back 54

1. Meningitis
2. Epiglottitis
3. Pneumonia
4. Septic arthritis
5. Osteomyelitis
6. Pericarditis
7. Cellulitis
8. "acute exacerbation of chronic bronchitis"

Front 55

Which is incorrect in regards to Neonatal conjunctivitis?
1. The most common cause is chemical irritation {day 1}
2. The most threatening is Neisseria gonorrhoeae.
3. The "Rule of fives" is a mnemonic for helping predict the most likely bacterial aetiology based on timing of presentation.
4. presentation 0-5 days = N gonorrhoeae
5. presentation day 5 to 5 weeks = Haemophilus influenzae

Back 55

5. 5 days to 5 weeks = Chlamydia trachomatis

Front 56

Causes of Neonatal Conjunctivitis ?

Back 56

1. Chemical
2. Bacterial
- N gonorrhoeae
- Chlamydia trachomatis
- Haemophilus species.
- Streptococcus species
- Staphylococcus
3. Viral
- HSV 1 / 2

Front 57

Rule of fives and presentation of neonatal conjunctivitis?

Back 57

0-5 days = N gonorrhoeae
5 days to 5 weeks = Chlamydia
5 weeks to 5 years = Haemophilus influenzae / Streptococcus

Front 58

Complications from Neisseria gonorrhoeae Neonatal conjunctivitis ?

Back 58

1. Corneal ulcers
2. Corneal perforation
3. permanent corneal scarring
4. Blindness

Front 59

Traveller's Diarrhoea: which is incorrect?
1. Usually caused by ETEC {Enterotoxigenic E Coli}
2. Antibiotics can shorten the illness.
3. The antibiotic used is a quinolone.
4. Symptoms usually last 7-10 days
5. Contaminated salad / ice or bottled water is the source.

Back 59

4. 3-4 days

Front 60

In regards to food poisoning, which statement is incorrect?
1. The most common food-borne bacterial pathogen is Campylobacter jejuni.
2. Bacteria associated with preformed toxins are Staphylococcus and Bacillus.
3. Unrefrigerated rice is associated with Clostridium.
4. Contaminated poultry and dairy = Salmonella
5. Undercooked meats / poultry = Campylobacter.

Back 60

3. Unrefrigerated rice = Bacillus

Front 61

Which is least likely associated with bloody diarrhoea in food poisoning?
1. EHEC {Enterohaemorrhagic E coli.}
2. Shigella
3. Camplylobacter
4. EIEC {Enteroinvasive E coli}
5. Salmonella.

Back 61

5. Salmonella

Front 62

Which is incorrect in regards to Body Fluid exposure:
1. Greatest risk of death is from Hepatitis
2. Wearing of latex gloves decreases inoculum by 50%
3. HIV needlestick risk when source positive: 0.3%
4. A high or increased risk of HIV infection in the source is a recommendation for PEP
5. PEP can reduced the risk of seroconversion by 50%.

Back 62

5. At least 80%

Front 63

Which is incorrect in regards to PEP Treatment?
1. Low risk exposure = 4 weeks zidovudine + lamivudine
2. High risk exposure = addition of lopinavir + ritonavir
3. PEP is well tolerated
4. There is no evidence to support use of PEP for NON OCCUPATIONAL exposure to HIV.
5. PEP should ideally be commenced within 1 hour of injury.

Back 63

3. Full course tolerated by < 35% due to adverse effects.

Front 64

Which is incorrect in regards to Blood testing with body fluid exposure:
1. test Source for HIV and HCV
2. Test Source for Anti-HBsAg
3. test Exposed for HBsAg
4. Test exposed for AntiHBsAg
5. Test exposed for HIV and HCV

Back 64

Test Source for :
1. HBsAg
2. HIV
3. HCV
Test Exposed for:
1. HIV
2. HCV
3. HBsAg
4. Abti-HBsAg

Front 65

What are the low transmission risk body fluids in HIV ?

Back 65

1. Faeces
2. Mucous
3. Saliva
4. Sweat
5. Urine
6. Vomit
UNLESS CONTAMINATED WITH BLOOD

Front 66

BODY FLUID FACTS: Which is incorrect?
1. HBV transmission risk 5% if source is e antigen negative
2. HCV transmission risk = 3% following percutaneous exposure
3. HBV transmission risk 40% if e antigen positive
4. Needlestick injury risk for HIV = 0.3%
5. Highest risk for HIV transmission is insertive anal intercourse.

Back 66

5. receptive anal intercourse = 0.8%
insertive anal intercourse = 0.1%
Shared IV drug equipment = 0.6%

Front 67

Which organism is the least likely to be associated with a human bite?
A. Eikenella corrodens
B. Anaerobic bacteria: beta lactamase -producing
C. Pasteurella species
D. Staphylococcus and Streptococcus species.

Back 67

C. -more associated with Animal bites

Front 68

Which of the following organisms is least likely to be associated with an animal bite?
A. Capnocytophaga canimorsus
B. Pasteurella species
C. Staphylococcus and Streptococcus species.
D. Ureaplasma Urealyticum

Back 68

D. usually human related Urinary sepsis -associated organism.

Front 69

What are the mainstays of therapy for human and animal bites, besides antibiotics?

Back 69

1. Through cleaning -irrigation +/- debridement
2. Elevation
3. Immobilisation

Front 70

What are the factors associated with wounds having a high risk for infection?

Back 70

1. Delayed presentation > 8 hours
2. Puncture wounds- unable to be adequately debrided
3. Location : hands / feet / face
4. Underlying structures associated: bones / joints / tendons
5. Immunocompromised patient

Front 71

Which of the following antibiotics is not considered an appropriate therapy for Established cat bite infection?
A. Timentin 4.5 G IV
B. Metronidazole plus Ceftriaxone
C. Tazocin 3.1 G IV
D. Benzylpenicillin 1.2 G IV

Back 71

D.

Front 72

(Dunn et al.)
In regards to Meningococcaemia, which of the following is incorrect?
A. It's greatest age risk is < 5 years
B. Serogroups B and C are the main infecting types in Australia.
C. Early warning symptoms can include leg pains and cool extremities.
D. The rash is present in 80% cases.

Back 72

D. only present in 40% cases.

Front 73

(Dun et al.)
In regards to the laboratory findings in Meningococcaemia, which of the following is incorrect?
A. Blood cultures and blood PCR are high yield tests.
B. Urine PCR for meningococcus is poorly sensitive .
C. Serology (IgM and IgG) will not guide the initial management.
D. CSF PCR is imperative in acute meningococcal disease.

Back 73

D. No : The presence of petechiae / purpura is a contraindication to perform LP.

Front 74

(Dunn et al.)
which of the following is not a treatment option in meningococcaemia?
A. Surgical debridement and amputation.
B. Immediate antibiotics with benzylpenicillin
C. Intubation and ventilation for hypoxia / altered mental status.
D. IV fluid boluses and vasopressor support.

Back 74

B. Benzylpenicillin AND cefotaxime / Ceftriaxone.

Front 75

(Dunn et al.)
Which of the following is incorrect regarding menngococcaemia?
A. It is a notifiable disease.
B. An early differentiation from influenza is the absence of cough.
C. The vaccine only covers for serogroups A / B / W135 and Y.
D. Chemoprophylaxis is with with rifampicin / ceftriaxone or ciprofloxacin.

Back 75

C. A / C / W135 / Y