Infectology Past Papers

Agents causing of bacterial (pyogenic/purulent) meningitis?

• Neisseria meningitides (children; 15% of adults are symptomatic carriers),

• Hemophilus influenza B,

• Strep. Pneumoniae (adults)

• Listeria monocytogenes (neonates, >60 yrs, immunocompromised people)

Treatment of bacterial meningitis?

• The doctor has 1hr to start the treatment !!!!

• high dose of ATB (3rd gen cephalosporins - SP, NM, HI, Entero, Penicillin - NM, vancomycin - SP, gentamycin - Entero, LM),

• corticosteroids (dexamethasone; 30 mins before antibiotic treatment to reduce inflammation)

• antipyretics

• mannitol (increase CSF pressure)

• fluids

Pregnant women should not be vaccinated for influenza?

False → neonates are too young to be directly immunized, thus vaccination during pregnancy is critical. Transplacentally transfered antibodies persist for about 6 months

Common misdiagnosis of pneumonia

Acute bronchitis, CHF, pulmonary edema

Which of these diseases are not prevented by vaccination?

Malaria

Main clinical symptoms of salmonellosis

• Fever,

• abdominal cramps,

• greenish diarrhoea

• nausea, vomiting

How can we treat acute Hep A?

Symptomatic therapy

Etiological agent of Lyme disease

borrelia burgdorferi via tick (vector)

HIV attack these cells in the immune system?

CD4 cells (type of T cells)

HPV in AIDS patients is manifested as

• Genital warts,

• flat warts,

• skin warts,

• neoplasia of the cervix, vagina, penis and anus

Which type of hepatitis is transmitted parenterally?

• Hep B

• Hep C

• Hep D

Which disease caused by Strep. Pyogenes?

Scarlet fever

• erythrogenic toxin,

• strawberry tongue,

• exanthema with white dermographism

• Sramek’s sign – white papule around fingernails and external ear,

• Filat’s sign – facial erythema with circumoral pallor

Symptoms Of early phase of Lyme disease

• Erythema migrans,

• flu-like symptoms

Treatment for hepatitis C

Anti viral treatment: interferon-free therapy using direct acting antivirals (DAAs), which are always in combination of 2 or 3 drugs

Causing viral (aseptic) meningitis?

• Enteroviruses (85% of cases)

• VZV,

• HSV,

• HIV

• mumps

Treatment for influenza?

• Symptomatic - rest, rehydration, analgesics, antipyretics, vitamins

• Antiviral - neuraminidase inhibitors = Oseltamivir (effective if given within 48 hours to first symptoms → the highest rate of replication)

Vaccination for influenza is recommended to?

• people > 50 yrs

• people with chronic lung diseases, heart diseases, liver diseases

• immunosuppressed people

• people who live in nursing homes

• healthcare workers

• pregnant women

Complication of streptococcal pharyngitis

Tonsillar abscess

Virus causes acute gastroenteritis

Rotavirus

• fecol-oral transmission

• severe diarrhoea

• prophylaxis with live-attenuated vaccine

Which hepatitis we have vaccination?

• A = inactivated vaccine

• B = recombinant vaccine

• Combination vaccine = inactivated virus for Hepatitis A and the recombinant HBsAg for Hepatitis B

Most common cause of ARDS (characterized by sudden and severe inflammation and fluid buildup in the alveoli of the lungs)?

• Sepsis

• pneumonia

• trauma

IV acyclovir for?

Herpetic (HSV-1) encephalitis

Time take to develop AIDS (from HIV)?

Depends on the patent immune/health status

Patient has diarrhea, go to doctor when…

Dehydrated, fever

Treatment for MRSA?

vancomycin

What is sepsis?

life threatening organ dysfunction caused by dysregulated response of host organism to infection

Transmission of HIV?

• sexual contact across mucosal surfaces

• maternal-infant exposure (vertical transmission)

• percutaneous inoculation

• bodily fluids (blood, semen, vaginal secretions, breast milk)

Protection from AIDS

• physical contraception

• PrEP (tenofovir disoproxil fumarate and emtricitabine)

• PEP (combo of 3 antiretroviral drugs)

Cause of pseudomembranous colitis

C. difficile

Typical community acquired pneumonia is caused by?

• Streptococcus pneumonia

• H. Influenzae

• Mycoplasma pneumoniae

• Chlamydia pneumoniae

• S. aureus

• Legionella pneumophila

Salmonella typhi murium causes

gastroenteritis (non-typhoidal salmonellosis)

CURB-65 score evaluate

assess the severity of community-acquired pneumonia (CAP)

• Confusion

• Urea > 7 mmol/L (20 mg/dL).

• Respiratory Rate ≥ 30 breaths per minute.

• Blood Pressure: Systolic blood pressure < 90 mmHg or diastolic blood pressure < 60 mmHg

• 65: ≥ 65 years

Which diseases of travellers are preventable by vaccination?

• Japan Encephalitis

• Yellow fever

• Dengue fever

• Typhoid fever

• Tick-borne encephalitis

• Rabies

• TB

• Cholera

• M-pox (also used for smallpox)

Who is COVID-19 more dangerous for?

• people with certain underlying health conditions (e.g. cancer, lung disease, heart disease, etc)

• older age

• obesity

• DM

• immunocompromised

What is the most common first clinical manifestation of herpes simplex infection?

herpetic gingivostomatitis (HSV-1)

• Shallow, yellowish ulcers with red border in oral cavity

• fever

• halitosis

Infectious mononucleosis is caused by?

EBV

Which type of vector transmit the Lyme disease?

ticks (Ixodes Ricinus)

What do you need to consider when selecting ATB therapy?

• site of infection,

• comorbidities,

• severity of infections

• type of suspected pathogen

• dosage

Which of these are symptoms of a bacterial meningitis?

• purulent CSF

• triad = fever, headache + nuchal rigidity

• Nausea, vomiting, dilated poorly reactive pupil (increased intracranial preasure)

• photophobia (irritation of sensitive spinal roots)

• decreased level of consciousness

• petechial rash (meningococcemia)

What are signs of meningeal irritation?

• Nuchal rigidity (resistance to forward flexion)

• Kernig’s sign (pain when extending knee from 90-degree position)

• Brudzinski’s sign (pain on forward flexion of neck while knee is bent)

• Lassegue test (pain when examiner lifts straight leg of lying patient)

Typical clinical findings in patient with infectious mononucleosis are?

• sore throat

• cervical lymphadenopathy

• hepatosplenomegaly

• tonsillitis

• fever

• malaise

What is not true about empirical antibiotic treatment?

1. is a therapy based on experience

2. is a therapy strictly based on the results of cultivation

3. it is applied before the confirmation of a definitive medical diagnosis

4. it is typically broad-spectrum

2

What does SARS-CoV2 stand for?

severe acute respiratory syndrome coronavirus 2

Typical laboratory findings of CSF in a patient with bacterial meningitis are?

• low level of glucose

• high level of proteins

• neutrophilia / high polymorphonuclear cells

Which therapeutic steps should be delivered within one hour of the initial diagnosis of sepsis?

1. start fluid resuscitation with crystalloids (30ml/kg/3h, normal MAP ≥ 65mmHg),

2. administer ATB treatment

3. take blood culture

What are the complications of COVID-19?

• acute liver injury

• bacterial pneumonia

• pulmonary embolism

• acute respiratory failure

• DIC

The most common diarrheal nosocomial infection is?

colitis caused by Clostridium difficile

What type of viral hepatitis could be transmitted by sharing needles when using drugs?

• Hep B

• Hep C

• Hep D

WHEN TO ADMIT A CHILD TO THE HOSPITAL?

39 degrees fever

PNEUMONIA CAN BE CAUSED BY BACTERIA/VIRUS OR FROM INHALING FOOD OR LIQUIDS?

True

WHAT IS THE FIRST TREATMENT OF COMMUNITY-ACQUIRED PNEUMONIA?

• 3rd gen cephalosporins / broad spectrum Aminopenicillins

  AND

• Fluoroquinolones / Macrolides

WHAT IS THE CAUSATIVE THERAPY OF LYME DISEASE?

beta-lactams / doxycycline

WHAT ARE THE SYMPTOMS OF A HIV INFECTION?

• swollen lymphnodes

• fever

• tiredness/weakness

What is the most common HIV related neurological complication?

Toxoplasmosis

Which etiological agents can be cause of FUO?

• HIV-Associated FUO ← opportunistic infections, Immune Reconstitution Inflammatory Syndrome (IRIS), lymphoma, Kaposi’s sarcoma

• Classic FUO ← infections (TB, UTI, etc), culture-negative endocarditis, neoplasms, neoplastic fever, inflammatory diseases (e.g. rheumatoid arthritis)

• Nosocomial FUO ← drug fever, postoperative fever, PE

• Neutropenic FUO ← bacterial infections, fungal infections