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43 Cards in this Set
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Typhoid (gram negative rod) |
Constipation more than diarrhoea Relative bradycardia (Fagets sign) Rose spots (salmon pink rash) Cough Headache
Can be difficult to differentiate from malaria |
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Malaria |
Hypoglycaemia Anaemia Thrombocytopenia 3x negative blood films are needed to rule out malaria |
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Yersiniosis (yersinia enterocolitica) |
RIF tenderness (reactive appendicitis) Fever Diarrhoea (initial sx) Mouth ulcers Erythema nodosum (initial sx)
Other complications: uveitis, asymmetrical polyarthritis, glomerulonephritis |
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Syphilis |
Non treponemal test (used as screening): RPR - useful for monitoring titer. >1:1 confirms syphilis infection. 1:6 is higher than 1:4. VDRL - primarily used on CSF to diagnose neurosyphilis
Specific for T.P. antibodies (remains positive for life once infected) EIA, TP-PA, FTA-ABS, TPHA Latent: serologic proof but asymptomatic Early latent: less than 1 year after secondary syphilis |
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Diarrhoea ABX |
Cipro majority Metronidazole for anaerobe: - gardnerella -entamoeba - giardia - C. Diff |
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Cryptosporidium diarrhoea |
Oocysts in diarrhoea HIV positive? ?response to nitzoxanide |
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Meningococcal prophylaxis |
Oral cipro (1 dose) - first line Rifampicin (4 doses over 2 days) - second line |
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Rickettsia variants |
R. Conorii - tick bite eschar R. Prowzekii - typhus, body louse, discrete rash 6 days after onset of constitutional sx R. Rickettsii - Rocky Mountain spotted fever, sx starts 1-2 weeks after tick bite, rash starts as centripetal macular rash progressing to petechial rash by day 6 |
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Amoebiasis |
Pleural effusion +/- empyema Hepatic abscess
Treat with metronidazole for acute amoebic dysentery or hepatic amoebiasis (may also use tinidazole) Followed by 10 days of diloxanide furoate to destroy the cysts in the faeces. |
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Treponemal infections |
Yaws - T. Pertenue - multiple skin lesions which may ulcerate Pinta - T. Carateum - chronic pigmentary skin lesions |
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Strongyloides |
Nematode Larva migrans, larva currens (linear rash) Urticarial rash with eosinophilia Malabsorption/chronic diarrhoea Lung - Pneumonitis, loeffler syndrome
Treat with ivermectin for 48hours |
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Weil's disease (leptospirosis) - every blood test is abnormal!! |
Rat urine source of infection
Relatively normal WCC Thrombocytopenia Relative hyponatremia/hypokalaemia (?due to NKCC inhibition) Jaundice AKI Raised CK
Treat with IV Ben Pen or cephalosporins (or doxy if pen allergic) |
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Chlamydia Vs gonorrhoea |
Chlamydia microscopy neutrophils with no bacteria, most common cause of PID Gonorrhoea microscopy Gram negative diplococci |
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Brucellosis Vs hydatid |
Both can be transmitted by contact with infected livestock (eg sheep)
Brucellosis: back pain, transaminitis, leucoerythroblastic blood film, negative blood culture does not rule out brucellosis. Diagnosis requires bone marrow aspiration. Treat with 6 weeks of Doxycycline + streptomycin/rifampicin (rifampicin is oral but streptomycin is IM and more expensive hence rifampicin is preferred)
Hydatid disease: obstructive liver disease |
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Cryptococcal meningitis |
Immunocompromised Lymphocytic meningitis with high opening pressure, slightly low glucose. India ink positive
Cf TB meningitis (lymphocytic meningitis with normal opening pressure, very low glucose) |
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HIV encephalopathy Vs PML |
HIV encephalopathy: diffuse dementia, poor balance, ataxia, generalised motor weakness, hyperreflexia PML: more focal neurology eg hemiparesis, aphasia, ataxia, MRI shows multiple white matter lesions, CSF JC viral PCR or JC antibodies |
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Non-specific/non-gonococcal urethritis (NGU) |
Penile swab - neutrophils ++ but no organism seen Dysuria but no penile discharge
Azithromycin/Doxycycline |
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Mycobacterium avium complex (MAC) infection |
Immunocompromised Diarrhoea RUQ pain Lymphadenitis on CT abdo Non-TB AFB seen Deranged LFT |
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Culture negative infective endocarditis |
burnetti 1) coxiella burnetti2) Bartonella3) T. Whipplei 2) Bartonella 3) T. Whipplei |
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Antiretroviral SEs |
AZT eg zidovudine - dilated cardiomyopathy due to mitochondrial toxicity
PI eg ritonavir - hepatitis - pancreatitis - arrhythmia - indinavir can cause nephrolithiasis |
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Lyme disease |
Early: erythema migrans Late: flu like sx (arthritis etc), neurological sx (facial palsy, meningism) |
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Mycoplasma pneumonia |
Bullous myringitis Erythema multiforme Autoimmune haemolytic anaemia |
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Neurocysticercosis |
Taenia solium (undercooked pork) Diagnosis: direct visualisation of parasites through fundi CT head: cystic lesion Treatment: anticonvulsant for seizures, steroid for cerebral oedema |
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Cavitating pneumonia |
Staph aureus - more acute Klebsiella Pseudomonas Proteus Fungal Legionella |
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PCP |
Cotrimoxizole Methylpred if paO2<9.3 |
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Severe influenza |
Bilateral patchy consolidation Inhaled zanamivir |
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Leprosy (Hansen's disease) |
Diagnosis: AFB on skin biopsy, or DNA PCR
Treatment: dapsone, rifampicin, clomifizine for 6 months, or 2-5 years if lepromatous leprosy
Tuberculoid leprosy: few discrete lesions, early neurological changes
Lepromatous leprosy: systemic, loss of peripheral sensation |
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CMV infection |
Retinitis (haemorrhage and exudates on fundoscopy) Lymphadenopathy Hepatosplenomegaly IV ganciclovir first line IV foscarnet second line |
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Botulism |
ITU support due to CNS depression (eg respiratory muscle paralysis) IV BenPen and IV metro Drooping eyelid Double vision Sources: soil, water, pollen through wound, honey |
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Chagas disease |
Trypanosoma cruzi Indigestion Mega-oesophagus VTE Conduction defect Treat: nifurtimox |
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Shingles - role of oral antiviral |
- May reduce the incidence and severity of complications from ophthalmic shingles - may reduce the acute pain from herpes zoster, but no evidence in reducing incidence of post herpetic neuralgia
Needs to be started within 72hours of onset of rash |
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Dengue fever |
Thrombocytopenia Petechial rash Retro orbital headache No meningism Paracetamol and rehydration only. No indication for antibiotics |
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Giardiasis Vs tropical sprue |
Both can cause chronic diarrhoea and malabsorption Differentiate by region of travel Giardiasis: diagnose with stool antigen, treat with tinidazole or metronidazole Tropical sprue: jejunal biopsy shows villi flattening, treat with tetracycline or co-trimoxazole |
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Severe malaria |
Parasitemia of >10% BE <-8 Bicarb <15 Lact >5 |
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Albendazole interaction |
Albendazole reduces ATP availability for worms causing immobilisation and death Carbamazepine reduces albendazole efficacy Dexamethasone, praziquentel, cimetidine increase risk of albendazole toxicity |
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Leishmaniasis |
Skin lesion Marked splenomegaly Deranged LFT and ALP Usually asymptomatic so check HIV status Treat: sodium stibogluconate (other options include miltefosine, amphotericin, paromomycin, fluconazole) |
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Hydatid disease/echinococcus |
Tapeworm Affects liver, lung, brain Multiple cysts Diagnose with USS/CT/serology Avoid aspiration due to the risk of seeding Treat: surgical + albendazole (PAIR treatment if inoperable) |
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Filiriasis (a group of diseases) |
Wucheria Bancrofti cause Elephantiasis+hydrocele
Onchocerciasis cause "river blindness"
Diagnose: finger prick test for thin and thick film and giemsa stain at the right time. Eg night time for W. Bancrofti, and day time for Loa Loa Treat: Diethylcarbamazine (DEC), ivermectin |
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Swimmer's ears/otitis externa |
think Pseudomonas in immunocompromised (will not respond to co-amox, may need meropenem) Needs ENT referral |
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Renal biopsy histology |
Crescent - rapidly progressive GN (eg Goodpasture, lupus nephritis) Thick GBM with IgG and C3 - membranous GN (ass. w. Bronchial ca) Kimmelstiel-Wilson lesions - diabetic nephropathy Fusion of podocyte foot processes (on electron microscopy) - minimal change GN, common in childhood Necrotising granulomata - TB |
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3 types of amyloidosis |
Symptoms depend on the site of amyloid deposits - kidneys: nephrotic syndrome - heart: heart failure - tongue: enlarged tongue - throat: hoarse voice - liver: hepatomegaly - vessels: amyloid purpura ie raccoon eyes - thyroid: hypothyroidism Diagnosis: fat pad biopsy Three types: AA - due to systemic inflammation eg RA, Ank Spond, PsA, JIA
AL - myeloma
Beta2microglobulin - accumulation of beta2microglobulin due to the use of conventional dialysis machine. X ray shows bony cysts. Treatment: use polyacrylnitrile or polysulphone dialysis machine |
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Anaemia in CKD |
Intravenous iron to top up iron store before considering EPO |
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Verrucae |
Topical salicylic acid - may need to be administered up to 12 weeks Cryotherapy |
