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Worms & helminths flashcards

15 high-yield MRCP Part 1 cards from the Intellect Medicos Infectious Diseases course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.

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1. What is the first-line treatment for Strongyloides stercoralis?

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   Ivermectin (albendazole is the alternative).

   Why? Strongyloides can autoinfect and persist for decades after travel.

2. Which drug group can trigger Strongyloides hyperinfection syndrome?

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   Corticosteroids (and other immunosuppression, e.g. HTLV-1 infection, transplant).

   Why? Larvae multiply massively and carry gut bacteria into the blood, causing Gram-negative sepsis and meningitis.

3. A slowly moving serpiginous skin track after walking barefoot on a beach is ______; a rapidly moving rash (larva currens) is Strongyloides.

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   cutaneous larva migrans

   Why? Cutaneous larva migrans is caused by dog/cat hookworm (Ancylostoma braziliense) and stays in the skin; treat with ivermectin or albendazole.

4. A slowly moving serpiginous skin track after walking barefoot on a beach is cutaneous larva migrans; a rapidly moving rash (larva currens) is ______.

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   Strongyloides

   Why? Cutaneous larva migrans is caused by dog/cat hookworm (Ancylostoma braziliense) and stays in the skin; treat with ivermectin or albendazole.

5. Which worm causes visceral larva migrans and ocular granulomas, and how is it caught?

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   Toxocara canis — swallowing eggs from soil contaminated by dog faeces.

   Why? Larvae wander through liver, lung and eye causing marked eosinophilia; treat with albendazole ± steroids.

6. What is the first-line investigation for threadworm (Enterobius vermicularis)?

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   Sticky tape test of the perianal skin, first thing in the morning before washing.

   Why? The female lays eggs around the anus at night; eggs are rarely in stool.

7. How is threadworm treated?

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   Mebendazole single dose, repeated after 2 weeks if needed, treating ALL household members at the same time (plus hygiene measures).

   Why? The repeat dose kills newly hatched worms; treating the household prevents reinfection.

8. Which blood finding is the main consequence of chronic hookworm infection?

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   Iron deficiency anaemia (± eosinophilia and hypoalbuminaemia).

   Why? Ancylostoma duodenale and Necator americanus attach to the small bowel and suck blood. Treat with albendazole plus iron.

9. Which tapeworm from raw fish can cause vitamin B12 deficiency?

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   Diphyllobothrium latum (fish tapeworm).

   Why? The worm competes for B12 in the gut, causing megaloblastic anaemia; treat with praziquantel.

10. How is neurocysticercosis (Taenia solium) treated?

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    Albendazole (± praziquantel) with corticosteroids, plus antiepileptics for seizures.

    Why? Steroids are started before antiparasitic drugs because dying cysts provoke inflammation and oedema.

11. What is the first-line imaging for hepatic hydatid disease, and what is the classic sign?

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    Ultrasound — daughter cysts and the "water lily" sign (floating detached membranes).

    Why? Echinococcus granulosus (dog → sheep cycle) forms cysts mainly in the liver, then lungs.

12. Which cancer is associated with chronic Schistosoma haematobium infection?

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    Squamous cell carcinoma of the bladder.

    Why? Eggs in the bladder wall cause chronic inflammation, fibrosis and calcification.

13. What is the first-line test for urinary schistosomiasis, and which sample is best?

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    Urine microscopy for eggs on a midday (terminal) urine sample.

    Why? Egg excretion peaks around midday. Intestinal species (S. mansoni/japonicum) are diagnosed by stool microscopy.

14. What is the treatment of schistosomiasis?

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    Praziquantel (± steroids in severe acute Katayama fever).

    Why? Katayama fever is the acute hypersensitivity phase weeks after freshwater exposure: fever, urticaria, cough and eosinophilia.

15. Which filarial worm causes "river blindness", and what is its treatment?

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    Onchocerca volvulus (blackfly); ivermectin.

    Why? Diagnose by skin snip biopsy. Loa loa (Calabar swellings) and Wuchereria bancrofti (elephantiasis) are treated with diethylcarbamazine.