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Medicine year 1 semester 1 > Foundation 3 > Flashcards

Foundation 3 Flashcards

1
Q

Why is hand hygiene important

A

Most infections are transmitted from the hand, helps protect others and yourself.

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2
Q

Transient skin flora

A

Found on the surface of the skin. Composition of the skin flora depends on the prevalent micro-organism. We acquire these flora through contact with people, objects and the environment. Picked up and passed on to others very easily. Antibacterial properties of the skin prevent long term survival. Majority removed through effective hand hygiene

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3
Q

Resident skin flora

A

The micro-organisms that are always on us, Found in deep crevices with moisture content- hair follicles, sebaceous glands, groin and between toes. Types vary according to body site but usually S.aureus. Not readily removed from skin or transferred to others. Can cause infections through open wounds i.e. in surgery. Can be harmful to vulnerable groups like neonatal or ICU patients

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4
Q

The most frequently missed areas of the hand during hand hygiene

A

Thumbs, finger webs and tips of fingers

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5
Q

When should you use soap in hand hygiene

A

1) If your hands are soiled, greasy or dirty
2) After several uses of gel because gel becomes sticky
3) After contact with body fluids
4) Prior to aseptic techniques, may require specialist soaps

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6
Q

When should you use gel in hand hygiene

A

On clean dry hands, all other times when you need to wash your hands. These are the rules for non-infectious patients

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7
Q

How to wash your hands

A

Start water running and thoroughly wet your hands, apply x1 dispenser of soap. Do the hand washing technique with the water running throughout. Turn off the water with your elbows. Dry your hands with a single use paper towel. Keep hands in good condition with moisturiser and cutting your nails regularly.

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8
Q

How to take of your hands in a clinical setting

A

Bare below the elbow including jewellery as they will stop us from washing our wrists effectively. Can were on plane band without stones or patterns, as bacteria can get between the stones. Cant have false nails, nail polish/ gel as bacteria can grow between the gaps in the nail polish and between the false nail and the nail bed.

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9
Q

When do you wash your hands

A

1) Before patient contact
2) After body fluid exposure risk
3) Before aseptic task i.e. changing a wound
4) After contact with patients surroundings, including notes and equipment, equipment also needs to be washed
5) Recommended when entering a ward or clinical area

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10
Q

Describe interprofessional education

A

When students from various professions learn from each other to improve collaboration and quality of care. Helps you put into practise teamwork skills and gain the skills needed to be part of a multi-disciplinary team in the future. Helps you understand peoples views on other healthcare groups.

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11
Q

Stereotyping professional prejudice in multidisciplinary team

A

Stereotyping is when a proffesional role is expected to act a certain way. May get the stereotypes from the media, past experience, career path we want to follow and comments people have made. Stereotypes may make people feel pressured to act a certain way, it can have a detrimental effect on a person’s self-esteem. It can negatively impact on someone’s ability to carry out a job. People can feel misunderstood by other colleagues

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12
Q

Health and social care boundaries

A

Both health professionals and social care should be well informed about the patients condition and their treatment plan.

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13
Q

Consent

A

The principle that a person must give their permission before they receive any type of medical treatment, test or examination

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14
Q

What is needed for consent to be valid

A

1) Voluntary- decision is made by the person themselves and not family members
2) Informed- they must have all the information about the procedure
3) Capacity- the person understands all the information given to them and can use this to make a decision about consent

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15
Q

Medical students and consent

A

The GMC states that patients need to know that you are a student so they can decide whether they want you involved in their care; you must respect their descision. If you have any concerns about a patients consent talk to your supervisor, you should not carry out a procedure without consent.

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16
Q

Confidentiality

A

Information that is meant to be kept secret or private, all information should be kept confidential unless a compelling reason against it.

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17
Q

Importance of confidentiality

A

Preserves trust between the patient and health professionals. Subject to legal and ethical safeguarding. Includes all information. Don’t discuss patients in a public area especially identifiable information. Only discuss with clinicians directly involved in their care

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18
Q

Anonymity

A

When someone’s name is not given and cant be worked out by context. Always anonymise patient information and delete it when no longer needed

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19
Q

GMC being professional on placement guidelines

A
  • Always introduce yourself to patients, letting them know your name and that you are a medical student.
  • When you meet a patient check they consent to having a student present
  • Make sure your ID badge is visible
  • Dress in line with dress code
  • Arrive on time
  • Attend offered induction sessions
  • Complete mandatory training arranged for you on placement
  • Make sure you know the rules and guidelines specific to your placement and how to raise concerns
  • Be honest with patients if you don’t know the answers to their questions
  • Never discuss patient identifiable information without their consent
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20
Q

What do you look at to identify a bacteria

A
  • Size, shape, colour- microscopy/imaging
  • Growth conditions- anaerobic/aerobic
  • Metabolic attributes (biochemistry)- some grow in different growth media/ biochemical tests
  • Serology- how they react to antibodies
  • DNR- molecular biology techniques such as PCR
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21
Q

Tests you do to identify the bacteria

A

Take a sample and grow it on an agar plate, you incubate it overnight. You pick the bacteria off the agar plate and take a gram stain to see what the bacteria looks like under a microscope. You look at colony shape, size and colour. Other biochemical and genetic tests occur and you can look at the blood Lysis as certain bacteria will cause it to change colour.

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22
Q

Viruses

A

Small infectious organisms that can only replicate inside other living cells as they don’t have their own machinery for genome replication, transcription or translation. Instead they take over the machinery of the host cell. Debate over whether they are alive because of this

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23
Q

Virus structure

A

A virion is a single virus particle. The genome (either DNA or RNA), capsid (a protein shell that encloses the genome). Genome and capsid make up the nucleocapsid. Enveloped viruses have a lipid bilayer derived from their host cell. Capsid proteins protect the genome from being damaged. Very small

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24
Q

Prion

A

A misfolded protein which is infectious, it replicates in the host by inducing normal proteins of the same type to adopt an abnormal structure. Replicates itself without genetic information. If lots of proteins misfold you get a build up of abnormal proteins forming an amyloid plaque (stop working and become insoluble) which can cause cell death. Consumption of prion aggregate can spread prion disease

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25
Q

Protozoa

A

A diverse set of unicellular eukaryotic organisms, cause a range of human diseases like malaria

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26
Q

Helminths

A

Multicellular worms which cause infections. I.e. tapeworms

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27
Q

Eukaryote structure

A 
Nucleus
Diploid chromosomes
Organelles
80s ribosomes
Membrane contains sterols
Only fungi have a cell wall
Move through complicated cilia
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28
Q

Prokaryote structure

A 
No nucleus
Haploid DNA with a few circular chromosomes
No organelles
70s ribosomes
No sterols in the cytoplasmic membrane
A cell wall
Asexual (binary fission) reproduction
Moves via flagella
Smaller then eukaryotes, bigger then viruses
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29
Q

Gram positive bacteria

A 
No outer membrane
Thick cell wall made of peptidoglycan (murein)
No Lipopolysaccharide
No endotoxin
Normally some teichoic acid
Normally Lipoic acid
Sometimes a capsule
Sensitive to Lysozyme
Sensitive to penicillin
Sometimes produce exotoxins
Stain purple in a gram stain
Have one layer of cell membrane
30
Q

Gram negative bacteria

A 
Yes an outer membrane
Thin cell wall
Yes Lipopolysaccharide
Yes endotoxin
No teichoic acid
No lipoic acid
Sometimes capsule
Insensitive to Lysozyme
Less sensitive to penicillin
Sometimes exotoxin production 
Stains pink in a gram stain
Has both an inner and outer cell membrane, either side of the cell wall
31
Q

Lipopolysaccharide (LPS)

A

These and endotoxins cause disease in Gram -ve cells, they are found on the outer membrane

32
Q

Capsulated bacteria

A

Means they can avoid detection within a human cell

33
Q

Lysozymes

A

Destroy cell walls, as Gram +ve cells have a more prominant cell wall they are more sensitive to them, same with penicillin

34
Q

Exotoxins

A

Chemicals secreted in the external environment

35
Q

Pili

A

Allow bacteria to adhere and attach to things

36
Q

Periplasm

A

The space between the inner and outer membrane, a lot of biochemistry happens here. Contains enzymes involved in transport degradation and synthesis, many of these are lipoproteins

37
Q

Teichoic acid

A

Essential for cell viability, shape determination and cell division.

38
Q

Gram +ve cell envelope

A

The cell walls is made of murein and contains peptidoglycan cross-links for strength. Contains techoic acid and lipo-techoic acid. The cell membrane contains porins

39
Q

Endotoxins

A

Protect against bile salt and lipophilic antibiotics, it causes the hosts immune response. Secreted by bacteria and normally cause damage to the host. Refer to the LPS complex associated with the outer membrane of the gram negative pathogen. They can enter the host when the bacterial cell dies. They are released from the cell upon lysis (breakdown of membrane), they are not secreted but are released when the cell is disrupted.

40
Q

Exotoxins

A

Secreted by bacteria and normally cause damage to the host

41
Q

Exotoxin more info

A 
Source- some Gram+ and some gram-
Secreted from cell
Polypeptide
Location of genes- plasmid or bacteriophage
High toxicity
Various clinical effects and modes of action
Antigenicity- induces antitoxins
Toxoids used as vaccines
Destroyed at 60 degrees
42
Q

Endotoxin more info

A 
Source- outer membrane of most Gram- cells and listeria
Not secreted from cell
Lipopolysaccharide
Genes are in the bacterial chromosome
Low toxicity
Causes fever, chock, hypotension, edema and DIC
Poorly antigenic
No vaccine
Stable at 100 degrees for 1 hour
Typical diseases- sepsis by GNR
43
Q

Enveloped virus’s

A

Virus’s which don’t have an envelope are resistant to dying so can persist in aqueous environments

44
Q

Pathogenic organism

A

An organism that can cause or has the potential to cause disease or infection, the more pathogenic a bacteria is the more likely it will cause a disease. A non-pathogenic bacteria does not cause disease

45
Q

Opportunistic bacteria

A

Take advantage of certain opportunities to cause disease, these are known as opportunistic conditions and can be a cut in the skin

46
Q

Disease

A

When the growth of a bacteria or components related to the bacteria cause damage to the host

47
Q

Opportunistic pathogens

A

Members of the normal body bacteria which cause disease when they find themselves in the wrong place

48
Q

Human microbiome

A

A collection of the microorganisms living in or on the human body. When someone is ill with a disease this composition changes. Includes eukaryotes, archaea, bacteria and virus’s

49
Q

What normal bacteria flora can do?

A
  • Transiently colonise- don’t interfere with the body systems, when we shake someone’s hand bacteria can go from one hand to the other. Colonise but then quickly disappear.
  • Permanently colonise- they reside permanently where they are transferred to and become part of your bacteria flora. They don’t interfere with body systems.
  • Cause disease- interfere with body systems and cause a pathologic response
50
Q

Commensal bacteria

A

The bacteria that are normally found colonising the healthy human body. Part of the microbiome. Bacterial flora is very diverse as different bacteria thrive in different areas. Changes with age and health

51
Q

Roles of bacterial flora

A

1) Protect against pathogenic bacteria- resident bacteria will outcompete pathogens for their niche
2) Aiding digestion
3) Vitamin production- vitamin K
4) Stimulates an immune response

52
Q

Disruption of bacterial flora

A

Leads to infection from opportunistic pathogens, may be because they are somewhere they shouldn’t be. Disruption can be caused by an immunocompromised state if pathogens can move into the body. Can also be ageing or prolonged hospitalisation, use of a catheter and antibiotics as they kill normal bacteria flora.

53
Q

Virulence factors

A

The factors that make bacteria more pathogenic, gives them the ability to cause disease

54
Q

What are the virulence factors

A

1) Entry into host
2) Adherence onto cell
3) Invasiveness- ability to spread
4) Toxin production- body is less able to protect itself
5) Immune evasion/derangement
6) Antibiotic resistance

55
Q

Virulence factors- immune evasion/ derangement

A

Evasion- helps persistence in the environment, capsule can help
Derangement- May secrete super antigens which cause excessive activation of the immune system and disrupts it

56
Q

Bacteria size

A

0.2-0.7 micrometres, differ in size and shape

57
Q

Gram stain

A

Positive is purple, negative is pink

58
Q

Bacteria shape

A

Cocci- Round/spherical i.e. Gonorrhea. Cocci can form groups together when they aggregate it could be a chain or group
Coccobacilli- i.e. meningitis, short rod
Bacillus- i.e. typhoid fever, long rod
Vibrio- i.e. cholera, curved rod shape
Spiral/spirillum- i.e. gastric ulcers, loose corkscrew
Spirochete- tight corkscrew, i.e. syphilis

59
Q

Bacteria endospores

A

Dominant forms of the bacteria that can survive high temperatures, high UV radiation, desiccation, chemical damage and enzyme destruction. When the environment goes back to normal the bacteria shed their endosporium (inert coating)

60
Q

Chain of infection

A

The infectious agent-> the reservoir (where the micro-organisms reside and multiple i.e. food, soil, people)-> site of exit -> transmission-> site of entry-> The susceptible host

61
Q

Direct contact transmission

A

Human to human contact, for example, touching or kissing, can also be from pregnant women to her foetus. Indirect contact can be air-borne, vector borne or from dirty equipment.

62
Q

Transmission in a clinical setting

A

Can be due to poor hand hygiene, not disposing clinical waste correctly, not enough cleaning and decontamination and not wearing PPE.

63
Q

Main steps in the viral life cycle

A

1) Attachment
2) Entry
3) Replication and protein synthesis
4) Assembly- new viral particles are formed
5) Release- some gain a lipid envelope, now free to infect others

64
Q

Virus attachment

A

The interaction between the proteins on the virus surface and the host cell, determines which virus the cell infects and is partly responsible for disease manifestation

65
Q

Virus replication and protein synthesis

A

Most viruses encode their own DNA polymerase/ RNA polymerase/ reverse transcriptase. The endosome strips the membrane of the virus, exposing the virus capsid which breaks down, so only the genome is left, meaning production of proteins can take place.

66
Q

Virus classification- Baltimore system

A

By genome type: double stranded DNA, single stranded DNA, double stranded RNA, single stranded RNA (positive and negative sense). There are also single stranded RNA virus’s which use reverse transcription during replication. 7 types of viral genome

67
Q

Double stranded DNA viruses

A

DNA polymerase is used to replicate the DNA, viral RNA polymerase transcribes the DNA into mRNA by producing a positive sense mRNA strand. This is translated using the host cells machinery into proteins. The proteins can assemble with genome and other components into new viruses.

68
Q

Single stranded RNA (negative sense)

A

Replicated using viral RNA polymerase to create positive sense mRNA. This can then be used to make proteins. The positive sense mRNA can also be replicated using RNA polymerase to form the viral genome. The proteins and genome produced can now combine to form potency viruses.

69
Q

Double stranded RNA (positive sense)

A

Can be directly converted to proteins. In order to be replicated it needs to be converted to a negative sense RNA intermediate, using the enzyme RNA polymerase. This can be used as a template to make more positive sense RNA.

70
Q

Retroviruses

A

They use the reverse transcriptase enzyme, converting RNA to DNA, the viral DNA is then integrated with the host cells. It is dormant till it is activated. It can then be transcribed using RNA polymerase to get viral RNA which can be translated into proteins. The DNA can also be replicated, you then get assembly of progeny viruses.

71
Q

Steps for hand washing

A

1) Rub palms together
2) Rub the back of your hands
3) Interlace fingers and rub hands together
4) Interlock fingers and rub the back of fingers
5) Rub thumb in a rotating manner then the space between the index finger and thumb
6) Rub fingertips on pals
7) Wash wrist in a rotating manner

Medicine year 1 semester 1 (44 decks)

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