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year 3 conditions > infections + A&E > Flashcards

infections + A&E Flashcards

1
Q

contrast the mode of transmission and the main differentiating symptoms of HSV1 vs HSV2

A

HSV1
- spread in childhood via saliva
- herpes labials, HSV encephalitis

HSV2
- spread via genital contact
- genital herpes (ulcers)

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2
Q

2 main risk factors for HSV

A

HIV
immunosuppressive medications

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3
Q

describe the symptoms of genital herpes

A

ulcers
painful
dysuria
pruritus

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4
Q

describe the symptoms of herpes labials

A

cold sores on/around lips
tingling sensation first, then the lesion develops

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5
Q

describe skin manifestations of HSV

A

erythema multiform - target lesions
erythema herpeticum - punched out erosions, rapidly progressive painful rash, seen in children with atopic eczema, life threateing –> Tx = IV acyclovir

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6
Q

what type of lymphadenopathy is seen in HSV

A

Tender Inguinal Lymphadenopathy

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7
Q

list some symptoms for HSV

A

genital ulcers
cold sores
tender inguinal lymphadenopathy
erythema multiform
eczema herpeticum
severe gingivostomatitis (erythema and painful ulcerations on the perioral skin and oral mucosa)

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8
Q

Ix for HSV

A

Viral PCR
→ order when lesions are present

Genital Herpes
→ nucleic acid amplification tests (NAAT)
(after obtaining swab of the base of the ulcer)

Viral Culture

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9
Q

Tx for HSV

A

oral acyclovir

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10
Q

what is the pathological mechanism of HIV

A

it is a retrovirus, so infects and replicates inside of CD4+ T cells and macrophages

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11
Q

incubation period of HIV

A

symptoms start 3-12 weeks after infection

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12
Q

signs and symptoms of HIV

A

fatigue
weight loss
night sweats
lymphadenopathy
shingles
recurrent candidiasis
TB
maculopapular rash
sore throat
oral ulcers
diarrhoea
genital STIs

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13
Q

which appears first, HIV p24 antigen or HIV antibodies?

A

HIV p24 antigens

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14
Q

what test can be used for staging in HIV

A

CD4 count

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15
Q

Ix for HIV

A

Combination Test (standard for diagnosis and screening)
→ HIV p24 Antigen + HIV antibody Test

Serum HIV Enzyme-Linked Immunosorbent Assay (ELISA)
→ positive for HIV antibodies
(however antibodies may not be present in early infection)

CD4 Count
→ indicates immune status and helps in staging process.

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16
Q

medication for HIV? and when should it be started

A

1st Line
→ antiretroviral therapy (ART) = two NRTIs and one PI/NNRTI
(should be started as soon as HIV diagnosed)

NRTI’s (AToZ)
⇒ zidovudine,
abacavir,
tenofovir

NNRTI’s
⇒ nevirapine,
efavirenz

Protease Inhibitors (all end in -navir)
⇒ indinavir,
nelfinavir,
ritonavir

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17
Q

PrEP vs PeP

A

HIV Preexposure Prophylaxis (PrEP) for individuals at high risk of contracting HIV

HIV Postexposure Prophylaxis (PEP) which is a short course of ART taken by patients after potential exposure to HIV

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18
Q

when should PEP be started and how long should it be taken for

A

started 72 hrs after exposure
taken for 4 weeks

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19
Q

what should be given to HIV pt if their CD4 count is <200

A

co-trimoxazole
prophylaxis against Pneumocystis jiroveci pneumonia

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20
Q

how do you asses for deeper collections or necrotising fasciitis in a surgical site infection

A

cross sectional imaging

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21
Q

preoperative prevention steps against surgical site infection

A

Don’t remove body hair routinely
(if you do, use electrical clippers instead of razors)

Antibiotic Prophylaxis
→ if placement of prosthesis or valve

Patient Advice
→ encourage weight loss,
smoking cessation,
optimise nutrition,
ensure good diabetic control

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22
Q

intraoperative prevention steps against surgical site infection

A

Prepare skin with alcoholic chlorhexidine

Cover surgical site with dressing

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23
Q

risk factors for surgical site infection (pt factors and operative factors)

A

pt factors
- obesity
- poor glucose control
- age
- smoking
- renal failure
- immunosuppression

operative factors
- preoperative shaving
- length of operation
use of antimicrobial prophylaxis
- skin protection
appropriate gown and sterile equipment

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24
Q

how to manage surgical site infection

A

remove any sutures and clips and allow pus to drain
empirical abx therapy

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25
Q

incubation period of HSV3 aka VSV

A

14 days

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26
Q

difference between shingles and herpes

A

shingles
- caused by VSV (aka HSV3)
only flares up once in lifetime

herpes
- caused by HSV1/2
- can have recurrent flare ups

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27
Q

after primary infection with VSV (chicken pox0, where can it remain latent in body

A

trigemina ganglia
dorsal root ganglia

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28
Q

in which 2 groups of ppl does VSV often reactivate to produce shingles

A

HIV
immunocompromised

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29
Q

how can VSV be spread

A

direct contact with lesions
airborne spread from resp particles

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30
Q

what type of rash is caused by VSV and how does it spread

A

vesicular rash
appears centrally, then spreads to extremities

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31
Q

describe presentation of shingles

A

acute, unilateral, painful blistering rash.
Prodromal period with burning pain over affected dermatome for 2-3 days.
Erythematous, macular rash → vesicular rash.
Patients are infectious until vesicles have crusted over
Should avoid pregnant women and immunocompromised whilst infectious.

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32
Q

tx for shingles

A

Tx = paracetamol and NSAIDs.
Can also give antivirals within 72 hrs.

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33
Q

VSV ix

A

PCR

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34
Q

VSV tx: supportive care, risk of moderate disease, risk of severe disease

A

Supportive Care
→ paracetamol

Risk of moderate-severe disease
→ oral antiviral therapy (aciclovir)

Risk of severe disease
→ IV antiviral therapy

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35
Q

Ramsay hunt syndrome cause and presentation

A

cause is VSV ion the geniculate ganglion of the facial nerve

LMN facial nerve palsy
Auricular pain is first feature, followed by unilateral facial nerve palsy and vesicular rash around the ear (may also get blisters on anterior 2/3 of tongue).

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36
Q

Ramsay hunt syndrome tx

A

oral acyclovir and prednisolone

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37
Q

cause and presentation of Herpes zoster opthalmicus

A

reactivation of the varicella-zoster virus in the area supplied by the ophthalmic division of the trigeminal nerve.

Causes vesicular rash around the eye and hutchinson’s sign (rash on the tip or side of nose).

Requires urgent opthalmology review

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38
Q

tx of herpes zoster opthalmicus

A

Requires urgent opthalmology review and oral antivirals for 7-10 days.

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39
Q

common 2 pathogens for surgical site infections

A

e coli
staph aureus

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40
Q

common 2 pathogens for nosocomial pneumonia

A

staph aureus
p aeruginosa

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41
Q

common pathogens for VAP (ventilator acquired pneumonia)

A

gram negative bacilli
- e coli
- klebsiella pneumonia
- p aeruginosa
- acinobacter

gram positive cocci
- stash aureus

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42
Q

most common pathogen for nosocomial UTIs

A

e coli

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43
Q

most common pathogen for nosocomial bloodstream infections

A

staph aureus

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44
Q

most common pathogen for nosocomial GI infections

A

c difficile

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45
Q

the protozoa of which genus causes malaria

A

plasmodium

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46
Q

which protozoan parasite causes the most deadly malaria

A

plasmodium falciparum

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47
Q

method of transmission of malaria

A

bite by an infected female anopheles mosquito or by blood transfusion / organ transplantation

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48
Q

give 2 protective conditions against malaria

A

sickle cell anaemia
G6PD deficiency

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49
Q

symptoms of malaria

A

Cyclical Fevers with chills and rigors (shivering)

Haemolytic Anaemia
→ causes jaundice and may turn urine dark

Splenomegaly

Headache

Weakness

Myalgia

Arthralgia

Anorexia

Diarrhoea

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50
Q

give some investigations for malaria

A

Giemsa-stained thick and thin blood smears
(Thick detects parasites present.
Thin detects species.)

RDTs (rapid diagnostic tests)
detect antigen, quick so useful in health resource-limited areas

FBC
(shows anaemia)

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51
Q

tx for malaria

A

chloroquine
or
hydroxychloroquine

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52
Q

what news score indicates sepsis

A

NEWS2 ≥5

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53
Q

when should blood cultures be taken in sepsis

A

immediately, before antibiotics are started

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54
Q

what is dos serum lactate level in sepsis indicate

A

determines severity of the sepsis

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55
Q

what does METABOLIC ACIDOSIS WITH RAISED LACTATE indicate

A

sepsis

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56
Q

how does sepsis affect urine output

A

decreased urine output

57
Q

describe the fluid resuscitation used in sepsis

A

500mL of crystalloid fluid

58
Q

which 3 drugs can be used for sepsis

A

Vasopressor + Ionotrope + Corticosteroid

59
Q

what is the most common causative agent of candidiasis

A

Candida albicans (a type od dimorphic fungi)

60
Q

describe the effect of candidiasis on the mouth

A

Oral Thrush
→ oropharyngeal region affected
White plaque in the oral cavity that can be scraped off, leading to inflamed areas.
Cottony feeling in the mouth.
Fissuring at mouth corners.
May be caused by ICS (beclamethasone) use in asthmatics

61
Q

what manifestation of candidiasis is considered an AIDS defining illness

A

oesophageal candidiasis
- causes odynophagia (retrosternal pain on swallowing)

62
Q

‘Cottage cheese’, non-offensive discharge from vagina
diagnosis

A

vulvovaginitis (vaginal yeast infection)

63
Q

what is vulvitis and what are the main symptoms

A

yeast infection if the outer part (vulva)
dysuria, dyspareunia

64
Q

vulvitis vs vaginitis vs vulvovaginitis

A

vulvitis = affect outer part (vulva)
vaginitis = affects inner part (vagina)
vulvovaginitis = affects both

65
Q

candidiasis investigation

A

Superficial Smear of Lesion for Microscopy

66
Q

tx for vaginl candidiasis

A

oral fluconazole

67
Q

list some topical antifungals

A

clotrimazole,
miconazole,
nystatin

68
Q

which antifungal can be used for systemic antifungal testament in severe candidiasis disease

A

fluconazole

69
Q

which 2 causative agents of dysentry have a short incubation period of 1-6 hrs

A

s aureus
bacillus cereus

70
Q

which 2 causative agents of dysentry have a long incubation period of 7 days

A

giardiasis
amoebiasis

71
Q

which causative agent of dysentry is common amongst travellers

A

e coli

72
Q

which causative agent of dysentry can cause steatorrhea, and lactose intolerance afterwards

A

giardiasis

73
Q

which causative agent of dysentry can cause GBS

A

campylobacter

74
Q

which causative agent of dysentry can cause profuse watery diarrhoea, severe dehydration and weight loss

A

cholera

75
Q

which causative agent of dysentry can cause HUS

A

haemolytic e coli

76
Q

which causative agents of dysentry can cause severe/projectile vomiting

A

s aureus - severe vomiting
bacillus cereus - vomiting within 6 hrs, diarrhoea after 6 hrs
norovirus - projectile vomiting

77
Q

which antibiotic can be used for severe campylobacter

A

clarithromycin

78
Q

which anabiotics can be used for moderate vs severe c diff

A

moderate - oral vanconycin
severe - IV metronidazole

79
Q

is HIV a notifiable disease

A

no

80
Q

process of reporting notifiable diseases

A

medical practitioner –> proper office at local health protection team –> health protection agency

report immediately, dont wait for lab confirmation
report within 3 days via form, or if urgent verbally within 24 hrs

81
Q

which antivirals can be used for hep c, and also for chronic hep b

A

interferon alpha
rivibarin

82
Q

what ix can be done to asses degree of cirrhosis in chronic hep c

A

liver biopsy

83
Q

which heps are RNA and which are DNA

A

RNA virus
- A, C, D, E

DNA virus
- B

84
Q

what type of virus is hep A

A

picarnovirus

85
Q

what type of virus is hep E

A

calcivirus

86
Q

what type of virus is hep B

A

hepadnovirus

87
Q

common cause of a chronic hep B pt having a super flare up

A

hep D infection

88
Q

which pts can hep D infect and why

A

is coated with HBsAg
so can only co-infect with hep B, or infect someone who already has hep B

89
Q

what does anti HBsAg antibodies indicate

A

immunisation either from
- recovery of infection –> if with IgG anti HBcAg
- vaccination —> if just alone, no HBcAg (only comes with an actual infection)

90
Q

which hep b antigen indicates high infectivity if present

A

HBeAg

91
Q

3 types of Hep b antigens

A

HBsAg –> surface (always present, antibodies don’t form against it until immunisation is reached either from recovery or vaccination)
HBcAg –> core (always present, antibodies form against it from start of infection, IgM indicates acute, IgG indicates chronic)
HBeAg –> envelope (not always present, but indicates high infectivity)

92
Q

which of IgG and IgM indicate chronic vs acute infections

A

IgM - acute
IgG - chronic

93
Q

most common cause of hepatocellular carcinoma worldwide vs UK

A

worldwide = chronic hep b
UK = chronic hep c

94
Q

main risk factors for hepatocellular carcinoma

A

liver cirrhosis secondary to hep B and C
alcohol
NAFLD
α-1-antitrypsin deficiency
Haemachromatosis

95
Q

raised ‘X’ is a useful diagnostic marker for hepatocellular carcinoma

A

AFP

96
Q

what 2 things are used for screening for hepatocellular carcinoma in ppl with hep b/c, haemochromatosis, alcohol abuse etc

A

USS
AFP levels

97
Q

which hep is particularly associated with travellers

A

hep A

98
Q

which hep is particularly associated with pregnancy

A

hep E

99
Q

incubation period of hep b / d

A

3 - 6 months

100
Q

incubation period of hep a / e

A

3 - 6 weeks

101
Q

which heps have vaccinations

A

hep A
hep B

102
Q

symptoms of acute vs chronic hep c

A

acute
- asymptomatic

chronic
- arthritis,
arthralgia,
eye problems (sjogren’s syndrome),
cirrhosis,
hepatocellular cancer,
cryglobulinaemia (vasculitis)
membranoproliferative glomerulonephritis (leading to renal dysfunction)

103
Q

what type of hypersensitivity is anaphylaxis

A

type 1 hypersensitivity reaction due to IgE-mediated mast cell activation

104
Q

describe the steps that lead up to an anaphylactic shock

A

Degranulation of Mast Cells
→ Massive Histamine Release
→ Systemic Vasodilation
→ Increased Capillary Leakage
→ Anaphylactic Shock

105
Q

list symptoms of anaphylaxis

A

Airway Swelling (Angio-Oedema)

Stridor,
Dyspnoea,
Wheezing,
Respiratory Arrest

Pale,
Clammy skin,
Hypotension,
Tachycardia,
Confusion

Urticaria,
Erythema,
Pruritus

106
Q

what can we look for in blood the indicates an anaphylactic shock

A

Mast-Cell Tryptase
→ may remain elevated for up to 12hrs after acute episode

107
Q

steps in managing anaphylactic shock

A
  1. remove trigger and call for help
  2. IM adrenaline + ABCDE + High flow oxygen (15L/min non-rebreathe mask)
  3. IV chlorphenamine 10mg + IV hydrocortisone 200mg

ALWAYS GIVE ADRENALINE IM EVEN IF PT HAS IV ACCESS (unless have refractory anaphylaxis)

108
Q

what are the adrenaline doses for different ages

A

< 6months = 100-150 mcg
6m - 6yrs = 150 mcg
6 - 12 yrs = 300 mcg
12yrs + = 500 mcg

109
Q

what is refractory Anaphylaxis and how is it treated

A

Refractory Anaphylaxis
⇒ persists despite 2 doses of IM adrenaline
(Tx with IV adrenaline and IV fluid bolus)

110
Q

what type of bleed is extradural, from which vessel and where on skull

A

arterial bleed
from middle meningel artery
pterion (thinnest part of skull)

111
Q

between which 2 layers is an extradural haemorrhage

A

dura
skull

112
Q

which layer is subdural haemorrhage in

A

outermost meningeal layer

113
Q

which lobes do subdural haemorrhages most commonly occur around

A

frontal
parietal

114
Q

2 main risk factors for subdural haemorrhage

A

old age
alcoholism

115
Q

onset of symptoms in subdural vs extradural haemorrhage

A

slower onset in subdural

116
Q

causes of subarachnoid haemorrhage

A

spontaneous due to cerebral aneurysm rupture
vs
traumatic brain injury

117
Q

classical presentation of extradural haemorrhage in terms of consciousness, neurological deficits and eyes

A

1) initial loss of consciousness following head injury
2) temporary recovery of consciousness with return to normal neurological function (lucid interval)
3) neurological status declines again due to haematoma expansion

contralateral focal neurological deficits

Signs of raised ICP

Compression of Occulomotor Nerve (CN3)
→ Fixed, dilated pupil

118
Q

which imaging is used for extradural haemorrhage and what does it show

A

Non-Contrast CT Scan
- biconvex lesion,
- hyperdense in appearance (brighter),
- limited by suture lines
- midline shift

eXtradural is conveX

119
Q

how can extradural haemorrhage lead to death

A

haematoma expansion
–> raised ICP
–> coning
–> death

120
Q

management of extradural haemorrhage

A

craniotomy and haematoma evacuation
ICP management
anticoagulants reversal

121
Q

what is resp arrest definition

A

cessation of breathing
pt has pulse

122
Q

extrapulmonary causes of resp arrest

A

CNS depression (opioid intoxication),

respiratory muscle weakness (myasthenia gravis, ALS),

airway obstruction (aspiration),

drowning,

Trauma

123
Q

pulmonary causes of resp arrest

A

airway obstruction (bronchospasm in asthma/COPD patients),

impaired alveolar diffusion(pulmonary oedema, pneumonia)

124
Q

resp arrets main symptoms

A

cyanosis
tachycardia
diaphoresis
altered mental state

125
Q

2 main ix for resp arrest

A

ABG
→ reduced oxygen,
increased carbon dioxide

Pulse Oximetry

126
Q

management of resp arrest

A

Intubation

Mechanical Ventilation

127
Q

define unstable angina

A

Myocardial ischaemia at rest or on minimal exertion in the absence of acute cardiomyocyte injury/necrosis

128
Q

sx of unstable angina

A

chest pain
dyspnoea
sweating
syncope

129
Q

ECG and troponin in unstable angina

A

ECG = normal
troponin = not elevated

130
Q

1st line for unstable angina

A

300 mg aspirin

131
Q

describe the steps from infection to MODS

A

SIRS + infection –> sepsis –> severe sepsis –> MODS

132
Q

what is MODS defined as

A

development of progressive and potentially reversible physiologic dysfunction of 2 or more organs or organ systems that is induced by a variety of insults, including sepsis

133
Q

stage 1 of MODS

A
  • increased volume and insulin requirements,
    mild respiratory alkalosis,
    oliguria,
    hyperglycaemia,
134
Q

stage 2 of MODS

A
  • tachypnoea,
    hypocapnia,
    hypoxaemia,
    moderate liver dysfunction
    haematologic abnormalities
135
Q

stage 3 of MODS

A
  • shock,
    azotaemia (high nitrogenous waste/creatinine/waste products in the blood),
    acid-base disturbance,
    significant coagulation abnormalities
136
Q

stage 4 of MODS

A
  • vasopressor dependent,
    oliguria or anuria,
    development of ischaemic colitis and lactic acidosis
137
Q

Mx of MODS

A

IV fluids
abx
vasopressor meds
blood transfusions
O2 therapy
technical ventilation
dialysis
ECMO
(+ surgeries needed etc)

138
Q

how to vasopressors affect bp

A

used to increase bp

year 3 conditions (17 decks)

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