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Phase 1 - S2 Infection > Clincal Conditions > Flashcards

Clincal Conditions Flashcards

1
Q

What is the presentation of someone with Neisseria meningitidus

A

Fatigue, fever, headache, stiff neck, non-blanching rash

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2
Q

What type of swab would you do for a suspected Neisseria meningitidus

A

Nasopharyngeal swab

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3
Q

What is the gram stain for Neisseria Meningitidsu

A

Gram negative diplococcus

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4
Q

What is the treatment of Neisseria Meningitidus

A

Ceftriaxone

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5
Q

What are the most common causative organisms of meningitis in newborns, children and adults

A

Newborns - E. coli, Group B streptococcus
Children - Haemophilius influenzae, Group B strep, Neisseria meningitidus
Adults - Neisseria menignitidus and Strep pneumoniae

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6
Q

What 2 things can E. coli present as

A
  • gastroenteritis

- UTI

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7
Q

How is E. coli spread?

A
  • perforated bowel

- feacal oral

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8
Q

What is the gram stain for E. coli?

A

Gram negative bacilli

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9
Q

What tests would you do to identify E. coli

A

Nitrites, leukocyte ester as expected, dipstick test, CRP, lactate

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10
Q

What is the treatment for E. coli and how does this antibiotic work?

A

Trimethoprim - inhibits folic acid synthesis

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11
Q

How does Haemophilius influenzae Present

A
  • as a URTI

- as meningitis

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12
Q

Where is Haemophilius influenzae found as part of the normal flora

A

Nasopharynx

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13
Q

What can staphylococcus aureus cause

A
  • skin infections
  • pneumonia
  • abscess
  • prosthetic infections
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14
Q

Where is staph aureus found as part of the normal flora

A

Skin and respiratory tract

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15
Q

What are the exotoxins for staph aureus

A
  • superantigens
  • coagulase enzymes
  • hyaluronidase
  • haemolysins
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16
Q

What is the gram stain for staphylococci

A

Gram positive cocci in clusters

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17
Q

What is the treatment for staph aureus and what do they do?

A

Penicillin but flucoxacillin if unsure it its strep - these are beta lactams which prevent cell wall synthesis

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18
Q

What microbes commonly cause prosthetic infections after surgery

A

Under 1 year - coagulase negative staphylococcus

Over 1 year - staph aureus or viridans streptococcus

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19
Q

What is used to treat MRSA

A

Vancomycin

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20
Q

How can you prevent biofilms forming on IV lines

A

Make silver coated IV lines

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21
Q

What can Staphlococcus epidermis cause?

A

Biofilm formations on equipment such as catheters

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22
Q

What are the 3 types of haemolysis for streptococci

A

Alpha - partially break down the RBCs
Beta - fully break down RBCs
Gamma - dont break down the RBCs

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23
Q

What are the 2 types of alpha streptococcus

A
  • strep pneumoniae

- viridans streptococcus

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24
Q

How does strep pneumoniae interact with the host

A

Enters the alveoli and stimulates an immune response so the alveoli fill with an exudate/pus. It may then infect the blood and cause complications.

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25
Q

What is the gram stain for streptococci

A

Gram positive cocci in chains

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26
Q

What commonly causes infective endocarditis

A

Viridans streptococcus

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27
Q

What are the features of infective endocarditis

A

Fever, heart murmur, janeway lesions, Osler nodes

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28
Q

Why must you look at dental hygiene with suspected infective endocarditis

A

As viridans streptococcus is naturally found in the mouth so could be able to enter the blood through poor dental hygiene

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29
Q

What type of beta streptococci are there

A

Streptococcus pyogenes

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30
Q

What are the virulence factors of streptococcus pyogenes

A
  • M protein
  • hyaluronic acid capsule
  • streptokinase
  • Exotoxins which cleave IgG
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31
Q

What is the presentation of strep pharyngitis

A

Sore throat, headache, pus exudate on tonsils

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32
Q

How do you treat strep throat

A

Initially only supportive to try and develop M protein specific antibodies

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33
Q

What are the complications of strep throat

A
  • peritonsillar abscess
  • post streptococcal glomerulonephritis
  • scarlet fever
  • rheumatic fever
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34
Q

What skin infections can strep pyogenes cause

A

Impetigo, erysipelas, cellulitis, necrotising fasciitis

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35
Q

How does strep pyogenes cause toxic shock syndrome

A

It invades into the blood stream and their superantigens cause the proliferation of T cells, releasing lots of cytokines leading to organ failure and vascular collapse

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36
Q

What is the gram stain for c diff

A

Gram positive bacilli

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37
Q

What is the treatment for c diff

A

Metronidazole

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38
Q

Why is c diff so hard to remove

A

It replicates using spores which are resistant to boiling water, chemical and UV so are very hard to remove

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39
Q

What are the exotoxins for c diff

A

Exotoxins A - causing inflammation

Exotoxins B - kills healthy gut cells by preventing protein synthesis

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40
Q

Why is using antibiotics a risk factor for developing a c diff infection

A

Antibiotics deplete the normal flora meaning there is reduced competition for the c diff

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41
Q

Describe the formation of a biofilm

A

The bacteria adhere to a surface
They begin to multiple and create a slime coating
Nutrients and other bacteria can move through this slime capsule into the biofilm

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42
Q

What are the advantages to the bacteria of a biofilm

A

Prevents competition from other bacteria, prevents complement and phagocytosis and prevents antibiotics

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43
Q

What is a vegetation

A

A collection of bacteria on heart valves

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44
Q

Where is E. coli found as part of the normal flora

A

Intestines

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45
Q

Where is h pylori found as part of the normal flora

A

Stomach

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46
Q

What is the grain stain for h pylori

A

Gram negative

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47
Q

What is the treatment for h pylori

A

Amoxicillin

48
Q

What are you at risk of developing from h pylori and why

A

Gastric ulcers, gastric adenocarcinoma and lymphoma of the MALT tissue. This is because the irritation/inflammation means the cells there regenerate so there’s more chances for mutation

49
Q

What are the signs of sepsis

A

High heart rate, high RR, low BP, high temperature, low oxygen saturation

50
Q

What is the sepsis sexist bundle

A
  • oxygen
  • fluids
  • antibiotics (e.g. Gentamicin)
  • measure urine output
  • measure lactate
  • blood culture
51
Q

How does an infection with candida present

A

Thrush - sore throat, white patches

52
Q

What puts you at risk of developing an infection with candida

A

Taking antibiotics as this depletes the normal flora

53
Q

When does candida only being infectious

A

When it overgrows

54
Q

What does aspergillosis cause

A

Fever, cough, chest pain, breathlessness

55
Q

Where is aspergillosis usually found

A

In dust in building

56
Q

What would the chest CT look. Like in aspergillosis

A

White patches with well defined edges

57
Q

Why may blood tests appear negative for aspergillosis

A

As the fungi stay localised and don’t travel around the blood and so a biopsy must be taken

58
Q

How does Adenovirus present

A

Fever, sore throat, enlarged lymph nodes, inflamed pharynx, no white patches on the throat
Can also cause gastroenteritis, conjunctivitis, pneumoniae

59
Q

What is the virus structure for adenovirus

A

Double stranded DNA, non enveloped

60
Q

How does Norovirus present

A

Vomiting, diarrhoea, dehydration

61
Q

What is the virus structure for norovirus

A

SsRNA, non enveloped

62
Q

How does EBV present

A

Fever, fatigue, swollen lymph nodes, enlarged spleen, rash (infectious mononucleosis)

63
Q

What does EBV do to lymphocytes

A
  • 50% increase in T cells of which 10% are abnormal

- stays latent in B cells

64
Q

What family of viruses is EBV part of

A

Herpes viruses

65
Q

What are the symptoms of hep b

A

Nausea, vomiting, jaundice, headache, abdominal pain

66
Q

What type of jaundice is seen in hepatitis

A

Intracellular-hepatic - where the liver cant conjugate the bilirubin

67
Q

What are the 3 types of hepatitis

A

Pre hepatic = increase in RBC breakdown
Intra hepatic = liver cant conjugate the bilirubin
Extra hepatic = blockage of the bile duct.

68
Q

What does hepatitis do to the liver

A

Causes inflammation as the virus replicates and kills hepatocytes

69
Q

How likely is it for hep b aand c to become chronic

A

More likely in hep c resulting in hepatocellular carcinoma, cirrhosis, liver disease

70
Q

What is the treatment for hep b

A

No treatment, only prevention. Therefore lifelong antivirals

71
Q

Give an example of an antiviral

A

Acyclovir

72
Q

What serology results are seen in hep b

A
  • increase in HbsAg
  • increase in HBeAG
  • increase in IgM
  • increase in HbeAb
  • increase in HbsAb
  • increase in IgG
73
Q

What would the liver function tests show in hepatitis

A

High ALT, AST and possibly ALP

Low albumin and coagulation factors

74
Q

What is the virus structure for hep b

A

DsDNA enveloped

75
Q

What is the serology like in hep c

A

Increase in anti-hepatitis C antibody

76
Q

What antigen must be present for chronic hep b - and how long must it persist for

A

HbsAg for over 6 months

77
Q

What is the virus structure of hep c

A

SsRNA enveloped

78
Q

What are the risks of needlestick for hep b, hep c and HIV

A

Hep b = 1/3
Hep c = 1/30
HIV = 1/300

79
Q

How does the primary stage of HIV present and what are the CD4 levels

A

Presents as a flu with a rash

CD4 levels are normal depsite lots of virus replicating

80
Q

What is the latent stage of HIV infection

A

CD4 starts to drop as virus continues to increase. No symptoms

81
Q

What is the somatic stage of HIV infection

A

CD4 drops below 350. Start to get opportunistic diseases

82
Q

What is the AIDS stage of HIV

A

CD4 below 200. Get opportunistic infections

83
Q

What opportunistic infections are likely in HIV

A 
Kaposi's sarcoma
PCP 
CMV
TB
Meningitis 
Oral candidiasis
84
Q

How does the virus interact with the host

A

Binds to CD4 receptors and empties its contents into the cell. Reverse transcriptase converts ssRNA into dsDNA and integrase adds this to host DNA. The host then produces viral proteins which cause inflammation and destroy the cell.

85
Q

What is the treatment for HIV

A

2 x reverse transcriptase inhibitors

1 of either an integrase inhibitor or a protease inhibitor

86
Q

Why are 3 drugs given in HIV

A

To prevent the chance of resistance

87
Q

What is the serology for HIV

A

HIV antigen and antibody tests

88
Q

What is the virus structure of HIV

A

SsRNA. Enveloped

89
Q

What can herpes zoster cause

A

Chicken pox and shingles

90
Q

How does shingles present

A

Pain, blistered rash which doesn’t cross the midline and affects a single dermatome

91
Q

Where does herpes zoster remain dormant

A

Root ganglion

92
Q

What is the virus structure of herpes zoster

A

DsDNA enveloped

93
Q

How does malaria present

A

Fever, sweating, chills, spleen enlargement, vomiting, cough, fatigue

94
Q

What is the incubation period of malaria

A

6 days

95
Q

What are the causative organisms of malaria

A

Plasmodium falciparum/ ovale/ vivax/ malariae

96
Q

What are the complication of plasmodium falciparum

A

Hypoglycaemia, renal failure, tachycardia, hypotension, cerebral problems, DIC

97
Q

What does malaria interact with the host

A

When the sporozites enter they goes via the blood to the liver where the enter the hepatocytes becoming merozoites. They replicate inside the cells eventually causing them to burst. They them travel in the blood to RBCs and will cause them to burst

98
Q

What is the vector of malaria

A

Female anopheles mosquito

99
Q

What tests do you do in malaria

A

3 blood films, FBC, coagulation, U+E, CXR

100
Q

What is the treatment for malaria

A 
Falciparum = artesunate (as its still in the liver)
Viva/ovale = primoquine and chloroquine
101
Q

What is the prevention for malaria

A

Preventing biting through nets, clothing, repellent

Antimalarials

102
Q

What is the risk of antimalarials

A

They deplete NADPH levels

103
Q

What is the presentation of typhoid

A

Fever, headache, abdominal discomfort, cough, Bradycardia

104
Q

What organism causes typhoid

A

Salmonella enterica

105
Q

What are the virulence factors for typhoid

A

Lipopolysaccharide
Fimbriae
Invasin

106
Q

What is the treatment of typhoid

A

Ceftriaxone

107
Q

What are the complication of re-infection of typhoid

A

Intestinal haemorrhage and perforation

108
Q

How does typoid spread

A

Fecal oral

109
Q

How can typoid be prevented

A

Better sanitation

110
Q

What causes dengue fever

A

Dengue virus - an arbovirus

111
Q

What is an arbovirus

A

A virus spread by mosquitoes

112
Q

How does dengue fever present

A

Rash, fever

113
Q

What type of organism is schistosomiasis

A

Helmith/ worm

114
Q

What consequences are there of schistosomiasis

A

Bladder cancer

115
Q

What are the symtoms of infection by schistosomiasis

A

Swimmers rash, fever, aching, general feeling of unwell

Phase 1 - S2 Infection (16 decks)

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